Provider Demographics
NPI:1992516215
Name:TEUBNER-HUMBER, MELANIE (LPN, CHW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:TEUBNER-HUMBER
Suffix:
Gender:F
Credentials:LPN, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9258 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75645-6435
Mailing Address - Country:US
Mailing Address - Phone:903-216-4833
Mailing Address - Fax:
Practice Address - Street 1:9258 WINDING WAY
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75645-6435
Practice Address - Country:US
Practice Address - Phone:903-216-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059886164X00000X
171M00000X
TX17254172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator