Individual
MELISSA J. DYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2805 N KNOXVILLE AVE, PEORIA, IL 61604-2869
(309) 624-9400
(309) 624-2280
Mailing address
2805 N KNOXVILLE AVE, PEORIA, IL 61604-2869
(309) 624-9400
(309) 624-2280
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
209-006545
IL
364SM0705X
Medical-Surgical Clinical Nurse Specialist
209-006545
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
809840
MEDICARE GROUP #
IL
01
—
CA4079
RR GROUP #
IL
01
—
P00397410
RR INDIVIDUAL #
IL
Enumeration date
04/09/2007
Last updated
10/11/2010
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