Individual
THERESA ELIZABETH MELLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1320 MAPLEWOOD AVE, RONCEVERTE, WV 24970-8016
(304) 647-4411
Mailing address
1320 MAPLEWOOD AVE, RONCEVERTE, WV 24970-8016
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3100
WV
207Q00000X
Family Medicine Physician
TRAINING
WV
Other
Enumeration date
06/04/2015
Last updated
01/20/2020
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