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NPI Code Detail

MEDICARE: MELINDA ANNETTE PENA APNP

MEDICARE: MELINDA ANNETTE PENA APNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner209.035981IL

General Provider Information

NPI Number : 1972182962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA ANNETTE PENA APNP
Provider Business Mailing Address
First Line : 1401 E STATE ST
Second Line : PO BOX 16
City : ROCKFORD
State : IL
Zip : 61104-2315
Country : US
Telephone Number : 779-696-4123
Fax Number :
Provider Business Practice Location Address
First Line : 1401 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61104-2315
Country : US
Telephone Number : 779-696-4123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2021
Last Update Date : 07/02/2026

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Directions to “ MELINDA ANNETTE PENA APNP” Practice Location

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