Provider Demographics
NPI:1649881970
Name:PASQUE, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PASQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 S PHILADELPHIA ST
Mailing Address - Street 2:APT 5206
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703
Mailing Address - Country:US
Mailing Address - Phone:918-720-1332
Mailing Address - Fax:
Practice Address - Street 1:HARDING UNIVERSITY PHYSICIAN ASSISTANT PROGRAM
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72149-0001
Practice Address - Country:US
Practice Address - Phone:501-279-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SD1360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program