Provider Demographics
NPI:1902324411
Name:BRELIE, MELISSA (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:BRELIE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-3945
Mailing Address - Country:US
Mailing Address - Phone:815-616-0876
Mailing Address - Fax:
Practice Address - Street 1:7604 W FOREST PRESERVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3202
Practice Address - Country:US
Practice Address - Phone:773-456-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide