Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2656-33 | WI |
NPI | 1003904137 |
---|---|
Provider Name | Melissa L Quandt |
First Address | Milwaukee, WI 53215-1748 |
Second Address | Milwaukee, WI 53215-1748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41267700 | (05) | WI |
Q65644 | (02) | WI |