Provider Demographics
NPI:1902201791
Name:ALLISON, MELINDA SUE (APN)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:SUE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2560 24TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5357
Mailing Address - Country:US
Mailing Address - Phone:309-779-3111
Mailing Address - Fax:309-779-3115
Practice Address - Street 1:2560 24TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5357
Practice Address - Country:US
Practice Address - Phone:309-779-3111
Practice Address - Fax:309-779-3115
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209011846363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care