Provider Demographics
NPI:1508193020
Name:STRODA, MELANIE LR (MSN,APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LR
Last Name:STRODA
Suffix:
Gender:F
Credentials:MSN,APRN, FNP-BC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LR
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN
Mailing Address - Street 1:631 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66111-3581
Mailing Address - Country:US
Mailing Address - Phone:913-461-7755
Mailing Address - Fax:
Practice Address - Street 1:3922 BARRING TRCE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2500
Practice Address - Country:US
Practice Address - Phone:309-692-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily