Provider Demographics
NPI:1932864287
Name:MEHLHAFF, KALEN A (RN)
Entity Type:Individual
Prefix:
First Name:KALEN
Middle Name:A
Last Name:MEHLHAFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KALEN
Other - Middle Name:A
Other - Last Name:MEHLHAFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3200 CANYON LAKE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8114
Mailing Address - Country:US
Mailing Address - Phone:606-355-2500
Mailing Address - Fax:
Practice Address - Street 1:3200 CANYON LAKE DR STE 1
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8114
Practice Address - Country:US
Practice Address - Phone:606-355-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR055326163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse