MEDICARE: MELISSA ELEONOR MULDER

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1588008098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ELEONOR MULDER

Provider Business Mailing Address
First Line	:	210 N SUTRO TER
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-0212
Country	:	US
Telephone Number	:	775-671-8523
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 N SUTRO TER
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-0212
Country	:	US
Telephone Number	:	775-671-8523
Fax Number	:

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

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/26/2013

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Directions to “ MELISSA ELEONOR MULDER ” Practice Location

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