Provider Demographics
NPI:1649619768
Name:LONG, MELISSA (APN, FNP-BC, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:APN, FNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22285 N PEPPER RD STE 401
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2542
Mailing Address - Country:US
Mailing Address - Phone:847-839-4391
Mailing Address - Fax:847-882-6228
Practice Address - Street 1:3880 SALEM LAKE DR
Practice Address - Street 2:F
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5292
Practice Address - Country:US
Practice Address - Phone:847-719-2220
Practice Address - Fax:847-719-2265
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209010475Medicaid
IL209010475Medicaid