Provider Demographics
NPI:1629365036
Name:WADE, MELISSA DENISE (DNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DENISE
Last Name:WADE
Suffix:
Gender:F
Credentials:DNP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:650 N SAM HOUSTON PKWY E STE 105B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-5918
Mailing Address - Country:US
Mailing Address - Phone:281-272-1743
Mailing Address - Fax:281-272-1758
Practice Address - Street 1:650 N SAM HOUSTON PKWY E STE 105B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060
Practice Address - Country:US
Practice Address - Phone:281-272-1743
Practice Address - Fax:281-272-1758
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP120465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX335469YKYNMedicare PIN