Healthcare Provider Details

I. General information

NPI: 1366035628
Provider Name (Legal Business Name): HOLLI DRENDEL PH.D., FACMGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL COLLEGE OF WISCONSIN, WDL BUILDING, RM 208 9200 W. WISCONSIN AVE
MILWAUKEE WI
53226
US

IV. Provider business mailing address

203 N 88TH ST
MILWAUKEE WI
53226-4615
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-4862
  • Fax:
Mailing address:
  • Phone: 515-708-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: