Provider Demographics
NPI:1417197609
Name:WHITE, MELISSA ILENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ILENE
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
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 701456
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-1456
Mailing Address - Country:US
Mailing Address - Phone:210-455-8132
Mailing Address - Fax:210-451-8179
Practice Address - Street 1:2319 BLUFFRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3947
Practice Address - Country:US
Practice Address - Phone:210-455-8132
Practice Address - Fax:210-451-8179
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690987171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator