Healthcare Provider Details

I. General information

NPI: 1285558924
Provider Name (Legal Business Name): MOLLY MEVERDEN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W GRAND AVE
WITTENBERG WI
54499-9276
US

IV. Provider business mailing address

400 W GRAND AVE
WITTENBERG WI
54499-9276
US

V. Phone/Fax

Practice location:
  • Phone: 715-253-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number178278-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: