Healthcare Provider Details

I. General information

NPI: 1487080479
Provider Name (Legal Business Name): MELISSA P HOHENSEE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E BEAUREGARD AVE
SAN ANGELO TX
76903-5919
US

IV. Provider business mailing address

PO BOX 22000
SAN ANGELO TX
76902-7200
US

V. Phone/Fax

Practice location:
  • Phone: 325-658-1511
  • Fax: 325-481-2166
Mailing address:
  • Phone: 325-658-1511
  • Fax: 325-484-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number746202
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: