Provider Demographics
NPI:1205993755
Name:SCHUPPAN, MELANIE IRENE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:IRENE
Last Name:SCHUPPAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:MELANIE
Other - Middle Name:IRENE
Other - Last Name:KYTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:708 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1714
Mailing Address - Country:US
Mailing Address - Phone:605-990-6213
Mailing Address - Fax:
Practice Address - Street 1:708 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1714
Practice Address - Country:US
Practice Address - Phone:605-990-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR024826163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse