Provider Demographics
NPI:1598097123
Name:MELPOLDER, GAIL DENISE (COMS, CLVT, CRC)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:DENISE
Last Name:MELPOLDER
Suffix:
Gender:F
Credentials:COMS, CLVT, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FAWN LN
Mailing Address - Street 2:
Mailing Address - City:LA LUZ
Mailing Address - State:NM
Mailing Address - Zip Code:88337-9339
Mailing Address - Country:US
Mailing Address - Phone:575-415-2008
Mailing Address - Fax:888-453-1138
Practice Address - Street 1:6 FAWN LN
Practice Address - Street 2:
Practice Address - City:LA LUZ
Practice Address - State:NM
Practice Address - Zip Code:88337-9339
Practice Address - Country:US
Practice Address - Phone:575-415-2008
Practice Address - Fax:888-453-1138
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4815 - ACVREP174400000X
5622 ACVREP174400000X
00016215 CRCC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist