=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851889331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA HILL CPNP-PC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2018
-----------------------------------------------------
Last Update Date | 04/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 TANGLEWOOD PKWY
-----------------------------------------------------
City | CASEYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62232-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-346-7640
-----------------------------------------------------
Fax | 618-344-9246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1230 TANGLEWOOD PKWY
-----------------------------------------------------
City | CASEYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62232-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-346-7640
-----------------------------------------------------
Fax | 618-344-9246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 209017476
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------