Individual
MS. PATRICIA SULLIVAN MELLINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN MSN APN/CNP
Contact information
Practice address
4405 WEAVER PKWY, WARRENVILLE, IL 60555-3269
(630) 933-4950
(630) 933-4958
Mailing address
4405 WEAVER PKWY, WARRENVILLE, IL 60555-3269
(630) 933-4950
(630) 933-4958
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209003910
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041164899
MEDICAID
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
F00096658
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
07/16/2007
Last updated
05/09/2018
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