Provider Demographics
NPI:1467507376
Name:WOLF, MELISSA DAVIS (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAVIS
Last Name:WOLF
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 DRYDEN RD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2400
Mailing Address - Country:US
Mailing Address - Phone:713-798-7356
Mailing Address - Fax:713-798-6374
Practice Address - Street 1:1709 DRYDEN RD
Practice Address - Street 2:SUITE 1700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2400
Practice Address - Country:US
Practice Address - Phone:713-798-7356
Practice Address - Fax:713-798-6374
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45053367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003383901Medicaid
LA1548791OtherLA - MEDICAID
88878COtherTX-BLUE SHIELD
TX430027845OtherRAILROAD - MEDICARE
TXTXB100151Medicare PIN
TX88878CMedicare PIN
TX430027845OtherRAILROAD - MEDICARE
TX003383901Medicaid