Provider Demographics
NPI:1962227124
Name:DUNCAN, M'LISSA ANN (MSMCT, RN, HNB-BC)
Entity type:Individual
Prefix:MS
First Name:M'LISSA
Middle Name:ANN
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MSMCT, RN, HNB-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 E NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953-1107
Mailing Address - Country:US
Mailing Address - Phone:217-974-5735
Mailing Address - Fax:
Practice Address - Street 1:804 E NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-1107
Practice Address - Country:US
Practice Address - Phone:217-974-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041397803163W00000X
IL043103777164W00000X
IL20868H2364SH1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse