Provider Demographics
NPI:1851889331
Name:HILL, MELISSA (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 TANGLEWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:CASEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62232-1101
Mailing Address - Country:US
Mailing Address - Phone:618-346-7640
Mailing Address - Fax:618-344-9246
Practice Address - Street 1:1230 TANGLEWOOD PKWY
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232-1101
Practice Address - Country:US
Practice Address - Phone:618-346-7640
Practice Address - Fax:618-344-9246
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017476208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics