Healthcare Provider Details

I. General information

NPI: 1841892890
Provider Name (Legal Business Name): MELISSA ANN SLOAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2020
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 W CUSTER AVE
MILWAUKEE WI
53218-3410
US

IV. Provider business mailing address

5031 W CUSTER AVE
MILWAUKEE WI
53218-3410
US

V. Phone/Fax

Practice location:
  • Phone: 414-232-3962
  • Fax:
Mailing address:
  • Phone: 414-232-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: