Individual
MELISSA LYNN GOODEARLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-8126
Mailing address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-8126
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
311205
WI
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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