Provider Demographics
NPI:1235853904
Name:CANTU, MELISSA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 N CALIFORNIA AVE UNIT 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1880
Mailing Address - Country:US
Mailing Address - Phone:910-322-8485
Mailing Address - Fax:
Practice Address - Street 1:4318 N CALIFORNIA AVE UNIT 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1880
Practice Address - Country:US
Practice Address - Phone:910-322-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.526617163W00000X
IL209.026069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse