Healthcare Provider Details

I. General information

NPI: 1366841579
Provider Name (Legal Business Name): DAVE MELDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N112W15568 MEQUON RD STE 5
GERMANTOWN WI
53022-3413
US

IV. Provider business mailing address

N112W15568 MEQUON RD STE 5
GERMANTOWN WI
53022-3413
US

V. Phone/Fax

Practice location:
  • Phone: 262-251-9911
  • Fax:
Mailing address:
  • Phone: 262-251-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: