Healthcare Provider Details

I. General information

NPI: 1326037789
Provider Name (Legal Business Name): MELVIN R STRADLING CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W UNIVERSITY DR STE 1
MESA AZ
85201-5833
US

IV. Provider business mailing address

2525 W BERYL AVE
PHOENIX AZ
85021-1606
US

V. Phone/Fax

Practice location:
  • Phone: 480-202-4515
  • Fax:
Mailing address:
  • Phone: 480-202-4515
  • Fax: 602-938-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN023521
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: