Provider Demographics
NPI:1487091856
Name:ALTHEIMER, MELISSA R (LPN)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:R
Last Name:ALTHEIMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 S DEER CREEK PKWY
Mailing Address - Street 2:UNIT 3207
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5330
Mailing Address - Country:US
Mailing Address - Phone:414-467-1377
Mailing Address - Fax:
Practice Address - Street 1:3601 S DEER CREEK PKWY
Practice Address - Street 2:UNIT 3207
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5330
Practice Address - Country:US
Practice Address - Phone:414-467-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-26
Last Update Date:2013-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI316838-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse