MEDICARE: MISS MELINDA CHANDLER LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	31829-031	WI

General Provider Information

NPI Number	:	1245477298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELINDA CHANDLER LPN

Provider Business Mailing Address
First Line	:	5023 N 54TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4206
Country	:	US
Telephone Number	:	414-339-0282
Fax Number	:	414-465-1900

Provider Business Practice Location Address
First Line	:	5023 N 54TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4206
Country	:	US
Telephone Number	:	414-339-0282
Fax Number	:	414-465-1900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	01/13/2009

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