Provider Demographics
NPI:1265053599
Name:WARREN, MELISSA (NURSE)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 W 97TH ST BSMT
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1446
Mailing Address - Country:US
Mailing Address - Phone:847-912-0324
Mailing Address - Fax:
Practice Address - Street 1:1900 E GOLF RD STE 950
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5034
Practice Address - Country:US
Practice Address - Phone:847-912-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043105285164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse