Provider Demographics
NPI:1346005022
Name:EVANS, MELISSA DAWN (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 N 2300 ST
Mailing Address - Street 2:
Mailing Address - City:BEECHER CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62414-2138
Mailing Address - Country:US
Mailing Address - Phone:618-292-1955
Mailing Address - Fax:
Practice Address - Street 1:108 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:IL
Practice Address - Zip Code:62411-1409
Practice Address - Country:US
Practice Address - Phone:618-881-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.445679163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty