Provider Demographics
NPI:1386259802
Name:MORAWIEC, MELANIE VANESSA
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:VANESSA
Last Name:MORAWIEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19211 TERRA ROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2343
Mailing Address - Country:US
Mailing Address - Phone:210-422-7360
Mailing Address - Fax:
Practice Address - Street 1:155 E SONTERRA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3988
Practice Address - Country:US
Practice Address - Phone:210-474-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007857363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner