Provider Demographics
NPI:1124757794
Name:WALDEN, MELINDA MARIE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:MARIE
Last Name:WALDEN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2516
Mailing Address - Country:US
Mailing Address - Phone:866-678-4699
Mailing Address - Fax:
Practice Address - Street 1:234 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2516
Practice Address - Country:US
Practice Address - Phone:866-678-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY50163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily