Provider Demographics
NPI:1538439161
Name:KRUGER, MELODY
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:KRUGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:DEACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 CHARLIE WULF ROAD
Mailing Address - Street 2:
Mailing Address - City:ANVIK
Mailing Address - State:AK
Mailing Address - Zip Code:99558-0528
Mailing Address - Country:US
Mailing Address - Phone:907-663-6334
Mailing Address - Fax:907-663-6326
Practice Address - Street 1:89 CHARLIE WULF ROAD
Practice Address - Street 2:
Practice Address - City:ANVIK
Practice Address - State:AK
Practice Address - Zip Code:99558-0528
Practice Address - Country:US
Practice Address - Phone:907-663-6334
Practice Address - Fax:907-663-6326
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker