Provider Demographics
NPI:1588499081
Name:MONDRAGON, MELISSA ANNE (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:MONDRAGON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4481 COQUETTE DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-9139
Mailing Address - Country:US
Mailing Address - Phone:608-751-8409
Mailing Address - Fax:
Practice Address - Street 1:224 CONNELLY DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-2222
Practice Address - Country:US
Practice Address - Phone:608-751-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI144480163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse