Provider Demographics
NPI:1841788403
Name:WOOTEN, MELISSA ROLFSEN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROLFSEN
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:ROLFSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3024 NEW BERN AVE STE G03
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1247
Mailing Address - Country:US
Mailing Address - Phone:225-205-4907
Mailing Address - Fax:
Practice Address - Street 1:3024 NEW BERN AVE STE G03
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1247
Practice Address - Country:US
Practice Address - Phone:225-205-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC238387390200000X
NC2022-00426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program