=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689542995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAINTBRUSH MEDICAL CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2025
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 WILLOW ST
-----------------------------------------------------
City | UPTON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82730-5144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-641-2933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 WILLOW ST
-----------------------------------------------------
City | UPTON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82730-5144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-641-2933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MELAYNEE TRANDAHL
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 605-641-2933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------