Provider Demographics
NPI:1679879506
Name:MELBY, ANGELA DAWN (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DAWN
Last Name:MELBY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E NEBRASKA ST TRLR 25
Mailing Address - Street 2:
Mailing Address - City:MUSCODA
Mailing Address - State:WI
Mailing Address - Zip Code:53573-8920
Mailing Address - Country:US
Mailing Address - Phone:608-739-2301
Mailing Address - Fax:
Practice Address - Street 1:24096 COUNTY HWY Z
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-5912
Practice Address - Country:US
Practice Address - Phone:608-383-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34772-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse