MEDICARE: MELISSA NICOLE WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	400572	TX

General Provider Information

NPI Number	:	1649988957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA NICOLE WHITE

Provider Business Mailing Address
First Line	:	10919 WEST RD APT 333
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-7207
Country	:	US
Telephone Number	:	713-478-5709
Fax Number	:

Provider Business Practice Location Address
First Line	:	10919 WEST RD APT 333
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-7207
Country	:	US
Telephone Number	:	713-478-5709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	11/07/2022

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Directions to “ MELISSA NICOLE WHITE ” Practice Location

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