Provider Demographics
NPI:1861090920
Name:MELROSE, ANTONETTE (RN)
Entity type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:
Last Name:MELROSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANTONETTE
Other - Middle Name:
Other - Last Name:MAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:319 E STERLING ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-5135
Mailing Address - Country:US
Mailing Address - Phone:832-414-9499
Mailing Address - Fax:
Practice Address - Street 1:3027 MARINA BAY DR STE 344
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3089
Practice Address - Country:US
Practice Address - Phone:281-968-2745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX806003163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse