Provider Demographics
NPI:1245477298
Name:CHANDLER, MELINDA (LPN)
Entity type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:
Last Name:CHANDLER
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 1:5023 N 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4206
Mailing Address - Country:US
Mailing Address - Phone:414-339-0282
Mailing Address - Fax:414-465-1900
Practice Address - Street 1:5023 N 54TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4206
Practice Address - Country:US
Practice Address - Phone:414-339-0282
Practice Address - Fax:414-465-1900
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31829-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse