Provider Demographics
NPI:1710700554
Name:INDAHL, MELINDA ESTEFANO
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:ESTEFANO
Last Name:INDAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 E BERGERON AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-9550
Mailing Address - Country:US
Mailing Address - Phone:480-859-0171
Mailing Address - Fax:
Practice Address - Street 1:10333 E BERGERON AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-9550
Practice Address - Country:US
Practice Address - Phone:480-859-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-310231174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN