Provider Demographics
NPI:1790914257
Name:VIACARA-KELLAR, MELODY JANE
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:JANE
Last Name:VIACARA-KELLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELODY
Other - Middle Name:JANE
Other - Last Name:KELLAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:14215 ROAD 28
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-5715
Mailing Address - Country:US
Mailing Address - Phone:559-675-7893
Mailing Address - Fax:559-674-7262
Practice Address - Street 1:14215 ROAD 28
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-5729
Practice Address - Country:US
Practice Address - Phone:559-675-7893
Practice Address - Fax:559-674-7262
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490010163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health