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General NPI Number Information
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NPI Number | 1467575092
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Entity Type | Individual
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Provider Name | MELISSA J. DYE
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Gender | Female
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 10/11/2010
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Provider Practice Location Address
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Address Line | 2805 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61604-2869
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Country | US
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Telephone | 309-624-9400
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Fax | 309-624-2280
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Provider Business Mailing Address
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Address Line | 2805 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61604-2869
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Country | US
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Telephone | 309-624-9400
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Fax | 309-624-2280
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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 | 364SM0705X
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Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
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License Number | 209-006545
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 209-006545
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License Number State | IL
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