Provider Demographics
NPI:1225680119
Name:ANDERSON, MELDA LOUISE (RN)
Entity Type:Individual
Prefix:
First Name:MELDA
Middle Name:LOUISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 KENDALL ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9770
Mailing Address - Country:US
Mailing Address - Phone:231-889-5584
Mailing Address - Fax:231-889-5584
Practice Address - Street 1:3839 KENDALL ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9770
Practice Address - Country:US
Practice Address - Phone:231-889-5584
Practice Address - Fax:231-889-5584
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704172256163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse