Healthcare Provider Details

I. General information

NPI: 1609637206
Provider Name (Legal Business Name): MELODY KATHLEEN RISTAU BSN, RN, CHPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 INTERNATIONAL WAY
SPRINGFIELD OR
97477-1047
US

IV. Provider business mailing address

1055 JUNIPER ST
JUNCTION CITY OR
97448-1935
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-7400
  • Fax:
Mailing address:
  • Phone: 541-255-5187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number200541535RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number200541535RN
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number200541535RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: