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General NPI Number Information
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NPI Number | 1902324411
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Entity Type | Individual
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Provider Name | MELISSA BRELIE CNA
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Gender | Female
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 7604 W FOREST PRESERVE AVE
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City | CHICAGO
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State | IL
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Zip | 60634-3202
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Country | US
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Telephone | 773-456-7832
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Fax |
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Provider Business Mailing Address
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Address Line | 804 WILLOW ST
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City | BELVIDERE
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State | IL
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Zip | 61008-3945
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Country | US
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Telephone | 815-616-0876
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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