1316178098 NPI number — MISS MELISSA LYNN MCDONALD RD, LDN

Table of content: MISS MELISSA LYNN MCDONALD RD, LDN (NPI 1316178098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316178098 NPI number — MISS MELISSA LYNN MCDONALD RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONALD
Provider First Name:
MELISSA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZDEB
Provider Other First Name:
MELISSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD,LDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316178098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3038 RANGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-421-6874
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3038 RANGE RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60124-3843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-421-6874
Provider Business Practice Location Address Fax Number:
847-421-6874
Provider Enumeration Date:
07/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  164.004772 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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