Provider Demographics
NPI:1871572362
Name:RENDLEN, MELISSA M (DO)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:RENDLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:FORRET
Other - Last Name:RENDLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4155 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:LAONA
Mailing Address - State:WI
Mailing Address - Zip Code:54541-9293
Mailing Address - Country:US
Mailing Address - Phone:715-674-7327
Mailing Address - Fax:
Practice Address - Street 1:4155 COUNTY ROAD H
Practice Address - Street 2:
Practice Address - City:LAONA
Practice Address - State:WI
Practice Address - Zip Code:54541-9293
Practice Address - Country:US
Practice Address - Phone:715-674-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118777207Q00000X
WI69199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine