Healthcare Provider Details

I. General information

NPI: 1629243803
Provider Name (Legal Business Name): MELISSA P WALTIGNEY CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA WALTIGNEY

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RIVERGATE
DURANGO CO
81301-7487
US

IV. Provider business mailing address

575 RIVERGATE
DURANGO CO
81301-7487
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-3154
  • Fax: 970-828-1666
Mailing address:
  • Phone: 970-259-3154
  • Fax: 970-828-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR43147
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: