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General NPI Number Information
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NPI Number | 1386130169
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Entity Type | Individual
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Provider Name | MELINDA SUE DEHORITY PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 1285 FRANCISCAN DR
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City | LITCHFIELD
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State | IL
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Zip | 62056-1778
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Country | US
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Telephone | 217-324-6127
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Fax | 217-324-5959
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Provider Business Mailing Address
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Address Line | 1414 W FAIR AVE STE 242
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City | MARQUETTE
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State | MI
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Zip | 49855-5406
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Country | US
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Telephone | 906-225-3333
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Fax | 906-225-3147
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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 |
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License Number State |
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