Healthcare Provider Details

I. General information

NPI: 1225083371
Provider Name (Legal Business Name): MELISSA M ILG N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/25/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S EDGEWOOD DR
KNOX IN
46534-8269
US

IV. Provider business mailing address

1001 S EDGEWOOD DR
KNOX IN
46534-8269
US

V. Phone/Fax

Practice location:
  • Phone: 574-772-4040
  • Fax:
Mailing address:
  • Phone: 574-772-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005407A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71005407A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: