Healthcare Provider Details

I. General information

NPI: 1790914257
Provider Name (Legal Business Name): MRS. MELODY JANE VIACARA-KELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELODY JANE KELLAR RN

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14215 ROAD 28
MADERA CA
93638-5729
US

IV. Provider business mailing address

14215 ROAD 28
MADERA CA
93638-5715
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-7893
  • Fax: 559-674-7262
Mailing address:
  • Phone: 559-675-7893
  • Fax: 559-674-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number490010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: