Provider Demographics
NPI:1790787356
Name:ROHRER, MELISSA A (PA C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:ROHRER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4019
Mailing Address - Country:US
Mailing Address - Phone:630-474-9254
Mailing Address - Fax:
Practice Address - Street 1:603 E PINE ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-4849
Practice Address - Country:US
Practice Address - Phone:918-587-2171
Practice Address - Fax:918-295-6155
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200007950BMedicaid
OK24313206Medicare ID - Type Unspecified
OK200007950BMedicaid