Provider Demographics
NPI:1295137164
Name:GRUNTMEIR, MELONDA FERRY
Entity type:Individual
Prefix:
First Name:MELONDA
Middle Name:FERRY
Last Name:GRUNTMEIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 NW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2408
Mailing Address - Country:US
Mailing Address - Phone:405-255-9642
Mailing Address - Fax:
Practice Address - Street 1:7012 NW 47TH ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2408
Practice Address - Country:US
Practice Address - Phone:405-255-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator