Provider Demographics
NPI:1609102631
Name:PEART, MELISSA ANN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:PEART
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:DENARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1177 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3952
Mailing Address - Country:US
Mailing Address - Phone:331-221-2820
Mailing Address - Fax:
Practice Address - Street 1:1177 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3952
Practice Address - Country:US
Practice Address - Phone:331-221-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant