Provider Demographics
NPI:1992540926
Name:MELISSA WENDELL MSN CNM LLC
Entity type:Organization
Organization Name:MELISSA WENDELL MSN CNM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:217-875-1886
Mailing Address - Street 1:1280 W ASH AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1208
Mailing Address - Country:US
Mailing Address - Phone:217-358-0639
Mailing Address - Fax:217-875-3120
Practice Address - Street 1:675 E SNYDER DR STE 1
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4701
Practice Address - Country:US
Practice Address - Phone:217-875-1886
Practice Address - Fax:217-875-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center