Provider Demographics
NPI:1194079111
Name:WENZEL, MELISSA ANN (ND)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:WENZEL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PETALUMA AVE
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4220
Mailing Address - Country:US
Mailing Address - Phone:707-492-5356
Mailing Address - Fax:707-492-5349
Practice Address - Street 1:130 PETALUMA AVE
Practice Address - Street 2:SUITE 2E
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4220
Practice Address - Country:US
Practice Address - Phone:707-492-5356
Practice Address - Fax:707-492-5349
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1915175F00000X
CAND622175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAND622OtherNATUROPATHIC MEDICINE COMMITTEE