=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053340992
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELODY ASPINWALL NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 01/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 512 E OGDEN AVE HEARTLAND CARE PARTNERS / MCHS WESTMONT
-----------------------------------------------------
City | WESTMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60559-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-375-5495
-----------------------------------------------------
Fax | 800-564-5952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11361 MILLER RD
-----------------------------------------------------
City | WATERMAN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60556-7106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 209.004537
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------