Provider Demographics
NPI:1679317119
Name:COCKRELL, MELINDA ANNE (RN-BC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANNE
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ANNE
Other - Last Name:IVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:936 QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1338
Mailing Address - Country:US
Mailing Address - Phone:708-908-0189
Mailing Address - Fax:
Practice Address - Street 1:936 QUAIL DR
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1338
Practice Address - Country:US
Practice Address - Phone:708-908-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041353584163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse