Provider Demographics
NPI:1619340957
Name:MICHALSKI, MELODY ANN (RN)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
Last Name:MICHALSKI
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:N1217 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:BIRNAMWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54414-9610
Mailing Address - Country:US
Mailing Address - Phone:715-881-2828
Mailing Address - Fax:
Practice Address - Street 1:N1217 COUNTY ROAD Y
Practice Address - Street 2:
Practice Address - City:BIRNAMWOOD
Practice Address - State:WI
Practice Address - Zip Code:54414-9610
Practice Address - Country:US
Practice Address - Phone:715-881-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225739-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse