Provider Demographics
NPI:1801132360
Name:SELL, MELISSA (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SELL
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SCHRAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMS, PA-C
Mailing Address - Street 1:724 N GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2236
Mailing Address - Country:US
Mailing Address - Phone:847-901-8400
Mailing Address - Fax:847-901-8410
Practice Address - Street 1:724 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2236
Practice Address - Country:US
Practice Address - Phone:847-901-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3734146363AM0700X
IL085.004553363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical