Provider Demographics
NPI:1023380490
Name:GUST, MELANIE A (LMT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:GUST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1814
Mailing Address - Country:US
Mailing Address - Phone:262-646-4727
Mailing Address - Fax:262-646-4729
Practice Address - Street 1:405 GENESEE ST
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1814
Practice Address - Country:US
Practice Address - Phone:262-646-4727
Practice Address - Fax:262-646-4729
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4453-046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist