Provider Demographics
NPI:1134632516
Name:HOUSE, MELISSA RAY (APRN, CNM, WHNP-BC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:RAY
Last Name:HOUSE
Suffix:
Gender:F
Credentials:APRN, CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S WOOD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1202
Mailing Address - Country:US
Mailing Address - Phone:312-996-2000
Mailing Address - Fax:312-413-2026
Practice Address - Street 1:1220 S WOOD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1202
Practice Address - Country:US
Practice Address - Phone:312-996-2000
Practice Address - Fax:312-413-2026
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016864363L00000X, 176B00000X
IL277001224367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicaid