Provider Demographics
NPI:1750526794
Name:RODEWALD, MELANIE A (ANP-BC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:RODEWALD
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:A
Other - Last Name:ROSSWURM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:6040 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1360
Mailing Address - Country:US
Mailing Address - Phone:317-956-6288
Mailing Address - Fax:317-956-6289
Practice Address - Street 1:6040 W 84TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1360
Practice Address - Country:US
Practice Address - Phone:317-956-6288
Practice Address - Fax:317-956-6289
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002801A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner