MEDICARE: MELISSA GOLDAL

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1366160400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GOLDAL

Provider Business Mailing Address
First Line	:	2750 N HWS CLEVELAND BLVD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-2687
Country	:	US
Telephone Number	:	402-289-2590
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 N HWS CLEVELAND BLVD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-2687
Country	:	US
Telephone Number	:	402-289-2590
Fax Number	:

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

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/15/2022

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Directions to “ MELISSA GOLDAL ” Practice Location

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