Provider Demographics
NPI:1346638947
Name:KNEIP, MELISSA JEAN (APN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEAN
Last Name:KNEIP
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E OGDEN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5569
Mailing Address - Country:US
Mailing Address - Phone:630-789-9785
Mailing Address - Fax:630-789-9798
Practice Address - Street 1:908 N ELM ST STE 404
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3638
Practice Address - Country:US
Practice Address - Phone:630-789-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.369990163W00000X
IL209012708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400222185Medicare PIN
ILF400222183Medicare PIN
ILF400222181Medicare PIN