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General NPI Number Information
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NPI Number | 1619524675
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Entity Type | Individual
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Provider Name | MELISSA OUELLETTE
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Gender | Female
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/06/2023
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5285
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Country | US
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Telephone | 571-231-3224
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Fax |
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Provider Business Mailing Address
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Address Line | 437 RIVERBIRCH DR
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City | VASS
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State | NC
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Zip | 28394-9551
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 962382
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 006984
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License Number State | NC
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