Provider Demographics
NPI:1508548611
Name:GASSOWAY, MELODY AMBER (RN)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:AMBER
Last Name:GASSOWAY
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 1:5053 HEATHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2964
Mailing Address - Country:US
Mailing Address - Phone:713-819-3103
Mailing Address - Fax:
Practice Address - Street 1:SIUE NURSE ANESTHESIA PROGRAM ALUMNI HALL 1066
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62026-0001
Practice Address - Country:US
Practice Address - Phone:618-650-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program