Provider Demographics
NPI:1912334301
Name:SCHUMACHER, MELISSA RENEE (CSFA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:SCHUMACHER
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:RENEE
Other - Last Name:SCHUMACHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSFA
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4644
Practice Address - Country:US
Practice Address - Phone:217-258-2440
Practice Address - Fax:217-258-2186
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027049363LF0000X
IL238000414246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily