Provider Demographics
NPI:1043007974
Name:MELDRUM, MEGUMI (FNP)
Entity type:Individual
Prefix:
First Name:MEGUMI
Middle Name:
Last Name:MELDRUM
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:MEGUMI
Other - Middle Name:MELDRUM
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7516 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-9757
Mailing Address - Country:US
Mailing Address - Phone:630-802-9685
Mailing Address - Fax:
Practice Address - Street 1:720 S VAN BUREN ST STE 201
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3534
Practice Address - Country:US
Practice Address - Phone:920-433-7488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1110701-30163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical