Provider Demographics
NPI:1598039661
Name:WENDELL, MELISSA KAY (CNM)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KAY
Last Name:WENDELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:675 E SNYDER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4766
Mailing Address - Country:US
Mailing Address - Phone:217-875-1886
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:62526-4766
Practice Address - Country:US
Practice Address - Phone:217-875-1886
Practice Address - Fax:217-875-3120
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL557190001Medicare PIN