Provider Demographics
NPI:1003904137
Name:QUANDT, MELISSA L (FNP, APNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:QUANDT
Suffix:
Gender:F
Credentials:FNP, APNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4111 W MITCHELL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-1748
Mailing Address - Country:US
Mailing Address - Phone:414-385-8800
Mailing Address - Fax:
Practice Address - Street 1:4111 W MITCHELL ST STE 300
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1748
Practice Address - Country:US
Practice Address - Phone:414-385-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2656-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41267700Medicaid
WI41267700Medicaid
WIQ65644Medicare UPIN