Provider Demographics
NPI:1366846537
Name:TOELLER, MELISSA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:TOELLER
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:W2637 CTY RD B
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:WI
Mailing Address - Zip Code:53019-1471
Mailing Address - Country:US
Mailing Address - Phone:414-640-6119
Mailing Address - Fax:
Practice Address - Street 1:W2637 CTY RD B
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:WI
Practice Address - Zip Code:53019-1471
Practice Address - Country:US
Practice Address - Phone:414-640-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI219723-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse