Provider Demographics
NPI:1699316588
Name:GOLDEN-BARNETT, MELISSA JOLYNN (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOLYNN
Last Name:GOLDEN-BARNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2110 SUSANNA WAY
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0801
Mailing Address - Country:US
Mailing Address - Phone:630-965-4965
Mailing Address - Fax:
Practice Address - Street 1:18 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3200
Practice Address - Country:US
Practice Address - Phone:312-592-6861
Practice Address - Fax:217-877-9452
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily