Provider Demographics
NPI:1316652597
Name:KUPHAL, MELISSA (HEALTH COACH PRACTIT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KUPHAL
Suffix:
Gender:F
Credentials:HEALTH COACH PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:53919-9663
Mailing Address - Country:US
Mailing Address - Phone:920-960-3329
Mailing Address - Fax:
Practice Address - Street 1:211 ELM ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:WI
Practice Address - Zip Code:53919-9663
Practice Address - Country:US
Practice Address - Phone:920-960-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach