Provider Demographics
NPI:1306094834
Name:BOSKUIL KONG-NDOUMBE, MELODY (BSN)
Entity type:Individual
Prefix:MS
First Name:MELODY
Middle Name:
Last Name:BOSKUIL KONG-NDOUMBE
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:MS
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:VOSKUIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:8407 REMAGEN ST APT B
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-2467
Mailing Address - Country:US
Mailing Address - Phone:262-354-2468
Mailing Address - Fax:
Practice Address - Street 1:4TH ST. AND G AVENUE, WEED ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:BUILDING 166, ROOM 414, ATTN: CREDENTIALS OFFICE
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5109
Practice Address - Country:US
Practice Address - Phone:760-380-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132473-030163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn