Provider Demographics
NPI:1386677052
Name:TRUBENBACH, MELISSA LEA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEA
Last Name:TRUBENBACH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-0370
Mailing Address - Country:US
Mailing Address - Phone:940-759-2226
Mailing Address - Fax:940-759-2385
Practice Address - Street 1:509 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252-2425
Practice Address - Country:US
Practice Address - Phone:940-759-2226
Practice Address - Fax:940-759-2385
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX600439363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183670201Medicaid
TX8N9525OtherBCBS TX
TX8G6740Medicare PIN
TX8N9525OtherBCBS TX