Healthcare Provider Details

I. General information

NPI: 1629309752
Provider Name (Legal Business Name): MELISSA G FORRETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA G GENTZ

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W MADISON AVE
MILTON WI
53563-1035
US

IV. Provider business mailing address

907 ROGERS ST
MILTON WI
53563-1755
US

V. Phone/Fax

Practice location:
  • Phone: 608-868-9246
  • Fax:
Mailing address:
  • Phone: 608-449-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number241943-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: