| NPI | 1285950451 |
|---|---|
| Former Name | MELINDA BETH HALLSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 60709-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 54048) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2021-03-09 |