Provider Demographics
NPI:1386637825
Name:TRUESDELL, MELANIE J (RNC, FNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:TRUESDELL
Suffix:
Gender:F
Credentials:RNC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:IDES/MEB CLINIC
Mailing Address - Street 2:BLDG 36036 WRATTEN
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-553-7267
Mailing Address - Fax:254-553-7511
Practice Address - Street 1:IDES/MEB CLINIC
Practice Address - Street 2:BLDG 36036 WRATTEN
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-553-7267
Practice Address - Fax:254-553-7511
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFNP004878Medicaid
TXFNP004878Medicaid