Healthcare Provider Details

I. General information

NPI: 1306010905
Provider Name (Legal Business Name): MELANIE PAIGE DIORIO CRNA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HIGHWAY 65 S
CLINTON AR
72031-6588
US

IV. Provider business mailing address

129 MOHAWK DR
MAUMELLE AR
72113-5860
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-7000
  • Fax: 501-745-2472
Mailing address:
  • Phone: 501-803-0250
  • Fax: 501-803-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC01189
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: