Individual
MELIA NICOLE MCCORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
801 E ORANGE ST, HOOPESTON COMMUNITY MEMORIAL HOSPITAL DBA CHARLOTTE ANN, HOOPESTON, IL 60942-1802
(217) 283-5644
(217) 283-7432
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2500
(217) 383-6792
(217) 383-4752
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085-002550
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085002550
STATE LICENSE NUMBER
IL
01
—
108919
HEALTH ALLIANCE
IL
Enumeration date
12/28/2005
Last updated
01/22/2015
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