Provider Demographics
NPI:1891970364
Name:WARE, MELITA C (ANP)
Entity Type:Individual
Prefix:MS
First Name:MELITA
Middle Name:C
Last Name:WARE
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Gender:F
Credentials:ANP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8109-43-1160
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-5298
Mailing Address - Fax:888-824-2176
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV SURG ACCS, STE 420
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-362-5298
Practice Address - Fax:888-824-2176
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2022-12-09
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Provider Licenses
StateLicense IDTaxonomies
MO154890363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429613201Medicaid
MO1891970364Medicaid