MEDICARE: MELANIE ANNE ANDERSON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	041370528	IL

General Provider Information

NPI Number	:	1184559627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE ANNE ANDERSON FNP-BC

Provider Business Mailing Address
First Line	:	6912 WATERFORD DR
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-8048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 W SUPERIOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5646
Country	:	US
Telephone Number	:	312-666-3494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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