Healthcare Provider Details

I. General information

NPI: 1730902248
Provider Name (Legal Business Name): MELAYNEE MARIE TRANDAHL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 E OAK ST
SUNDANCE WY
82729-5172
US

IV. Provider business mailing address

PO BOX 768
UPTON WY
82730-0768
US

V. Phone/Fax

Practice location:
  • Phone: 307-283-3501
  • Fax:
Mailing address:
  • Phone: 605-641-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number43295
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number43295
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: