MEDICARE: MELINDA KAY KLOPPEDAL RN, BSN, HTCP

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	163W00000X	Registered Nurse	87829-30	WI

General Provider Information

NPI Number	:	1942657820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA KAY KLOPPEDAL RN, BSN, HTCP

Provider Business Mailing Address
First Line	:	6359 GOOSE LAKE DR
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-9255
Country	:	US
Telephone Number	:	608-332-8432
Fax Number	:

Provider Business Practice Location Address
First Line	:	6359 GOOSE LAKE DR
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-9255
Country	:	US
Telephone Number	:	608-332-8432
Fax Number	:

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

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	05/19/2016

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