Healthcare Provider Details

I. General information

NPI: 1164809448
Provider Name (Legal Business Name): MRS. MELANIE LIEFFRING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MELANIE JANDRIN

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BELLINGER ST
EAU CLAIRE WI
54703-5222
US

IV. Provider business mailing address

PO BOX 1510
EAU CLAIRE WI
54702-1510
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-3311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3960
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: