Basic Information
| Provider Information | |||||||||
| NPI: | 1467507376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | DAVIS | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1709 DRYDEN RD | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137987356 | ||||||||
| FaxNumber: | 7137986374 | ||||||||
| Practice Location | |||||||||
| Address1: | 1709 DRYDEN RD | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137987356 | ||||||||
| FaxNumber: | 7137986374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 08/18/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 45053 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 003383901 | 05 | TX | MEDICAID | 1548791 | 01 | LA | LA - MEDICAID | OTHER | 88878C | 01 | TX-BLUE SHIELD | OTHER | 430027845 | 01 | TX | RAILROAD - MEDICARE | OTHER |