Provider Demographics
NPI:1649875220
Name:FAULHABER, MELINDA KAYE
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAYE
Last Name:FAULHABER
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 1:630 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6015
Mailing Address - Country:US
Mailing Address - Phone:701-290-4059
Mailing Address - Fax:
Practice Address - Street 1:630 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6015
Practice Address - Country:US
Practice Address - Phone:701-290-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty