Provider Demographics
NPI:1588696991
Name:GIFFORD, MELODY J (CNM, ARNP)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:J
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1627
Mailing Address - Country:US
Mailing Address - Phone:641-423-5044
Mailing Address - Fax:641-423-0994
Practice Address - Street 1:100 1ST ST NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3130
Practice Address - Country:US
Practice Address - Phone:641-423-5044
Practice Address - Fax:641-423-0994
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB058935367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP62346Medicare UPIN