Individual
MELISSA MARIE ILLIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-5000
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2268708
MA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2268708
MA
Other
Enumeration date
04/21/2019
Last updated
07/08/2019
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