Provider Demographics
NPI:1477397123
Name:GEIMAUSADDLE, MELINDA
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:GEIMAUSADDLE
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:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-0908
Mailing Address - Country:US
Mailing Address - Phone:580-492-3614
Mailing Address - Fax:580-492-5029
Practice Address - Street 1:PO BOX 908
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73502-0908
Practice Address - Country:US
Practice Address - Phone:580-492-3614
Practice Address - Fax:580-492-5029
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist