Provider Demographics
NPI:1952867681
Name:VITALE, MELISSA (PMHNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VITALE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 W BARRY AVE APT 4W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4359
Mailing Address - Country:US
Mailing Address - Phone:708-337-0891
Mailing Address - Fax:847-618-4198
Practice Address - Street 1:901 W KIRCHHOFF RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2361
Practice Address - Country:US
Practice Address - Phone:847-618-4197
Practice Address - Fax:847-618-4198
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00000000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041419664OtherRN LICENSE