Healthcare Provider Details

I. General information

NPI: 1518657170
Provider Name (Legal Business Name): MELISSA MARGUERITE URBAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA STONE

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 N SHERIDAN RD
WAUKEGAN IL
60085-2161
US

IV. Provider business mailing address

3656 CREEKSIDE CT
WINTHROP HARBOR IL
60096-1439
US

V. Phone/Fax

Practice location:
  • Phone: 847-360-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.027370
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: