Healthcare Provider Details

I. General information

NPI: 1801413083
Provider Name (Legal Business Name): MELISSA TREES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

IV. Provider business mailing address

7726 SPRING RIDGE DR
INDIANAPOLIS IN
46278-9594
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-4451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28197551A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: