| NPI | 1215313143 |
|---|---|
| Former Name | MELISSA LYNN PHELAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277.000385) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209013000) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2022-02-15 |