Healthcare Provider Details

I. General information

NPI: 1609821511
Provider Name (Legal Business Name): MELODY CATES APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ROCKTON AVE
ROCKFORD IL
61103-3619
US

IV. Provider business mailing address

2300 N ROCKTON AVE
ROCKFORD IL
61103-3619
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax: 815-971-9599
Mailing address:
  • Phone: 815-971-2000
  • Fax: 815-971-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number041290941
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: