Individual
MELANIE L PEQUIGNOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7910 W JEFFERSON BLVD STE 110, FORT WAYNE, IN 46804-4159
(260) 436-4116
(260) 436-1878
Mailing address
7910 W JEFFERSON BLVD STE 110, FORT WAYNE, IN 46804-4159
(260) 436-4116
(260) 436-1878
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001156
IN
Other
Enumeration date
02/22/2010
Last updated
06/05/2020
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