Healthcare Provider Details

I. General information

NPI: 1447051297
Provider Name (Legal Business Name): MELISSA MCDONALD WENZLER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 ROYAL DR UNIT 3F
MADISON AL
35758-2164
US

IV. Provider business mailing address

129 ROYAL DR UNIT 3F
MADISON AL
35758-2164
US

V. Phone/Fax

Practice location:
  • Phone: 256-874-9600
  • Fax:
Mailing address:
  • Phone: 256-874-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL313718
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: