Provider Demographics
NPI:1770263402
Name:ATTLEE, MELISSA ANN (CPM, LM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:ATTLEE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11425 COUNTY ROAD 506
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3560
Mailing Address - Country:US
Mailing Address - Phone:817-247-1151
Mailing Address - Fax:
Practice Address - Street 1:208 E BROAD ST STE 104
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1790
Practice Address - Country:US
Practice Address - Phone:817-257-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99520176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPM23060251OtherNORTH AMERICAN REGISTRY OF MIDWIVES