Individual
MRS. MELISSA THIBAULT MIKOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
4847 HOFFMAN BLVD, HOFFMAN ESTATES, IL 60192-3722
(847) 685-4646
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209010057
IL
363LF0000X
Family Nurse Practitioner
209010057
IL
363LF0000X
Family Nurse Practitioner
AP133930
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346673910
—
WA
01
—
G8923564
MEDICARE PTAN
WA
Enumeration date
08/18/2013
Last updated
03/25/2026
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