Provider Demographics
NPI:1063668994
Name:PENDLETON, DIONNA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:DIONNA
Middle Name:MARIE
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-3404
Mailing Address - Country:US
Mailing Address - Phone:715-539-2350
Mailing Address - Fax:715-539-2434
Practice Address - Street 1:601 S CENTER AVE
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-3404
Practice Address - Country:US
Practice Address - Phone:715-539-2350
Practice Address - Fax:715-539-2434
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54962-20207Q00000X
IL036.124091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine