Provider Demographics
NPI:1043943830
Name:RAMIREZ, MELISSA ELVIRA (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELVIRA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ELVIRA
Other - Last Name:MATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 MIDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1200
Mailing Address - Country:US
Mailing Address - Phone:815-252-6907
Mailing Address - Fax:
Practice Address - Street 1:1650 MIDTOWN RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1200
Practice Address - Country:US
Practice Address - Phone:815-223-6843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF06220105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily