Provider Demographics
NPI:1255587127
Name:MAZE, MELANIE V (ANP, BC)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:V
Last Name:MAZE
Suffix:
Gender:F
Credentials:ANP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-327-1202
Mailing Address - Fax:363-327-1222
Practice Address - Street 1:400 MEDICAL PLAZA
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1395
Practice Address - Country:US
Practice Address - Phone:636-639-8600
Practice Address - Fax:636-639-8676
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO080039363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health