Provider Demographics
NPI:1194971846
Name:PAROCHETTI, MELISSA LOUISE (CST)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LOUISE
Last Name:PAROCHETTI
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-3128
Mailing Address - Country:US
Mailing Address - Phone:815-878-6357
Mailing Address - Fax:
Practice Address - Street 1:3002 GILL ST
Practice Address - Street 2:SUITE#3
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3438
Practice Address - Country:US
Practice Address - Phone:309-846-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL100399246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant