Provider Demographics
NPI:1962707067
Name:WENDT, MELISSA M (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:WENDT
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2031 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5181
Mailing Address - Country:US
Mailing Address - Phone:715-421-7595
Mailing Address - Fax:316-759-6577
Practice Address - Street 1:57950 LEAVENWORTH ST STE 4E1
Practice Address - Street 2:
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221
Practice Address - Country:US
Practice Address - Phone:316-759-5050
Practice Address - Fax:316-759-6577
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2018-06-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program