Provider Demographics
NPI:1205228152
Name:MELESSE, GENET
Entity Type:Individual
Prefix:
First Name:GENET
Middle Name:
Last Name:MELESSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 GLASTONBURY TRL
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3468
Mailing Address - Country:US
Mailing Address - Phone:512-659-5990
Mailing Address - Fax:
Practice Address - Street 1:3612 GLASTONBURY TRL
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3468
Practice Address - Country:US
Practice Address - Phone:512-659-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)