Provider Demographics
NPI:1295582591
Name:MANKE, MELISSA E (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:MANKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2819 RAYCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-8305
Mailing Address - Country:US
Mailing Address - Phone:815-790-8019
Mailing Address - Fax:
Practice Address - Street 1:912 NORTHWEST HWY STE 206
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1925
Practice Address - Country:US
Practice Address - Phone:847-516-8187
Practice Address - Fax:847-516-8235
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.029618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine