Provider Demographics
NPI:1255438636
Name:HENNE, MELINDA B (MD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:B
Last Name:HENNE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 W PLEASANT GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3216
Mailing Address - Country:US
Mailing Address - Phone:801-785-5100
Mailing Address - Fax:801-785-4597
Practice Address - Street 1:1446 W PLEASANT GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3216
Practice Address - Country:US
Practice Address - Phone:801-785-5100
Practice Address - Fax:801-785-4597
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131549207VE0102X
UT14205993-1235207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020761500Medicaid
FLK0UWUOtherBCBS