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General NPI Number Information
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NPI Number | 1043630049
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Entity Type | Individual
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Provider Name | MELISSA L WINGO PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 3010 HIGHLAND PKWY STE 550
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5500
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Country | US
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Telephone | 630-724-1100
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Fax | 630-724-0084
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Provider Business Mailing Address
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Address Line | 1503 WATKINS LN UNIT 208
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City | NAPERVILLE
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State | IL
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Zip | 60540-7248
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Country | US
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Telephone | 847-691-8553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.004887
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License Number State | IL
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