Provider Demographics
NPI:1558351775
Name:POSSEHL, MELODIE KAYE (FNP BC APNP)
Entity Type:Individual
Prefix:MS
First Name:MELODIE
Middle Name:KAYE
Last Name:POSSEHL
Suffix:
Gender:F
Credentials:FNP BC APNP
Other - Prefix:
Other - First Name:MELODIE
Other - Middle Name:KAYE
Other - Last Name:POSSEHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP BC APNP
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-0324
Mailing Address - Country:US
Mailing Address - Phone:608-378-3888
Mailing Address - Fax:
Practice Address - Street 1:719 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2965
Practice Address - Country:US
Practice Address - Phone:715-675-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI139064030163W00000X
WI016282822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
R04957Medicare UPIN