Provider Demographics
NPI:1154507630
Name:WENNER, MELINDA E (DO)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:E
Last Name:WENNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2922
Mailing Address - Country:US
Mailing Address - Phone:936-205-5805
Mailing Address - Fax:936-205-5997
Practice Address - Street 1:2702 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2922
Practice Address - Country:US
Practice Address - Phone:936-205-5805
Practice Address - Fax:936-205-5997
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics