Doctor Name: | MELANIE A KAWULOK |
NPI Number: | 1093091381 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 17680.1131 |
Business Practice Address: | 1898 Fort Rd Sheridan, WY - 828018320 |
Business Phone Number: | 3076753112 |
Business Fax Number: | |
Mailing Address: | 1898 Fort Rd, SHERIDAN |
State: | WY |
Postal Code: | 828018320 |
Phone Number: | 3076753112 |
Fax Number: | |
NPI Enumeration Date: | 10/31/2011 |
NPI Last Update Date: | 10/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SF0001X |
License Number: | 17680.1131 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Family Health |
Taxonomy Definition: |