Provider Demographics
NPI:1598139115
Name:GZASKOW, MELISSA ANNE (RN, LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:GZASKOW
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 AVENIDA ALDEA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-9449
Mailing Address - Country:US
Mailing Address - Phone:505-795-7111
Mailing Address - Fax:
Practice Address - Street 1:66 AVENIDA ALDEA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-9449
Practice Address - Country:US
Practice Address - Phone:505-795-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR58980163W00000X, 163WI0500X, 163WP2201X, 163WX0200X
NM2770163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology