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General NPI Number Information
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NPI Number | 1366817223
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Entity Type | Individual
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Provider Name | MELISA MAROTTA PNP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 6545 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2313
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Country | US
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Telephone | 708-788-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 2842 MAYFAIR AVE
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City | WESTCHESTER
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State | IL
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Zip | 60154-5009
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Country | US
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Telephone | 708-289-2628
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209012848
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License Number State | IL
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