Healthcare Provider Details

I. General information

NPI: 1275375511
Provider Name (Legal Business Name): MELISSA RAE MORELAND KARL RN, HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2024
Last Update Date: 06/08/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13600 SW 42ND AVE
ELLENDALE MN
56026-2005
US

IV. Provider business mailing address

13600 SW 42ND AVE
ELLENDALE MN
56026-2005
US

V. Phone/Fax

Practice location:
  • Phone: 507-202-6184
  • Fax:
Mailing address:
  • Phone: 507-202-6184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: