Provider Demographics
NPI:1609637206
Name:RISTAU, MELODY KATHLEEN (BSN, RN, CHPN)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:KATHLEEN
Last Name:RISTAU
Suffix:
Gender:F
Credentials:BSN, RN, CHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-1935
Mailing Address - Country:US
Mailing Address - Phone:541-255-5187
Mailing Address - Fax:
Practice Address - Street 1:123 INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1047
Practice Address - Country:US
Practice Address - Phone:458-205-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200541535RN163WC1500X, 163WH0200X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health