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General NPI Number Information
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NPI Number | 1881788180
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Entity Type | Individual
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Provider Name | MELISSA AM HERTLER M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 15 SHRINE CLUB RD STE B
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City | LANDER
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State | WY
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Zip | 82520-8502
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Country | US
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Telephone | 307-332-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 15 SHRINE CLUB RD STE B
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City | LANDER
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State | WY
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Zip | 82520-8502
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Country | US
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Telephone | 307-206-1440
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Fax | 307-206-1444
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 51837-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | TL4446
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License Number State | WY
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