Provider Demographics
NPI:1912967258
Name:FRANK HANSSEN, MELISSA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:FRANK HANSSEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:106 19TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3700
Mailing Address - Country:US
Mailing Address - Phone:309-779-7068
Mailing Address - Fax:309-558-7026
Practice Address - Street 1:106 19TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3700
Practice Address - Country:US
Practice Address - Phone:309-779-7068
Practice Address - Fax:309-558-7026
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209115544363L00000X
IL209005544363L00000X
IAA087165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL41277877Medicaid
IA0492025Medicaid
045419OtherHEALTH ALLIANCE
IL1912967258Medicaid
IAP01325214OtherRR MEDICARE
IL8122900OtherBCBS
IA22524OtherBCBS
IA0492025Medicaid
ILF400101519Medicare PIN
Q66354Medicare UPIN
IL1912967258Medicaid
IA22524OtherBCBS