Provider Demographics
NPI:1598815425
Name:ZANDER, MELANIE MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:MARIE
Last Name:ZANDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-755-7366
Mailing Address - Fax:406-755-7277
Practice Address - Street 1:705 6TH AVENUE EAST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5047
Practice Address - Country:US
Practice Address - Phone:406-755-7366
Practice Address - Fax:406-755-7277
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN16588363LA2200X
MT100181363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0434996Medicaid
MT0434996Medicaid
MTS91888Medicare UPIN