Provider Demographics
NPI:1477713790
Name:DULIN, MELISSA LASUE (LSA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LASUE
Last Name:DULIN
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 ANTILLEY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5267
Mailing Address - Country:US
Mailing Address - Phone:325-428-5600
Mailing Address - Fax:325-428-5391
Practice Address - Street 1:1680 ANTILLEY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5267
Practice Address - Country:US
Practice Address - Phone:325-428-5600
Practice Address - Fax:325-428-5391
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00563363AS0400X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical