Provider Demographics
NPI:1497022586
Name:MACDONALD, MELISSA DAWN (APRN, CNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DAWN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE A200
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8437
Mailing Address - Country:US
Mailing Address - Phone:815-759-8070
Mailing Address - Fax:815-759-4931
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE A200
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-759-8070
Practice Address - Fax:815-759-4931
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007574363LA2200X
IL209007574363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209007574OtherSTATE LICENSE