Provider Demographics
NPI:1669012639
Name:MCNAMARA, MELISSA RENEE (ARNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 27TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-7005
Mailing Address - Country:US
Mailing Address - Phone:563-212-6551
Mailing Address - Fax:
Practice Address - Street 1:303 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-3042
Practice Address - Country:US
Practice Address - Phone:815-772-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041489686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse