Provider Demographics
NPI:1043509284
Name:JILOT, MELISSA LYNN (APNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:JILOT
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:MINERATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:1881 CHICAGO ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-3770
Practice Address - Country:US
Practice Address - Phone:920-403-8000
Practice Address - Fax:920-433-6009
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4422-33363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0211275OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
WI100016180Medicaid
WI163280OtherWI LICENSE