MEDICARE: MRS. MELODY HAIST NP

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	363L00000X	Nurse Practitioner	71000841A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71000841A	OTHER	IN	STATE LICENSE

General Provider Information

NPI Number	:	1639206378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELODY HAIST NP

Provider Business Mailing Address
First Line	:	1080 UNIVERSITY BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1256
Country	:	US
Telephone Number	:	765-914-5847
Fax Number	:	765-373-8579

Provider Business Practice Location Address
First Line	:	1501 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1914
Country	:	US
Telephone Number	:	765-962-1337
Fax Number	:	765-935-7509

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	12/10/2018

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