Provider Demographics
NPI:1356629612
Name:KARAFFA, MELISSA (APN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:KARAFFA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3006
Mailing Address - Country:US
Mailing Address - Phone:618-436-5665
Mailing Address - Fax:618-436-8042
Practice Address - Street 1:444 N PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3006
Practice Address - Country:US
Practice Address - Phone:618-436-5665
Practice Address - Fax:618-436-8042
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008867364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209008867OtherILLINOIS LICENSE