Healthcare Provider Details

I. General information

NPI: 1467760884
Provider Name (Legal Business Name): MELISSA LYNETTE TILLMAN-BERNARD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA LYNETTE BERNARD CRNA

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 SW 29TH ST
TOPEKA KS
66614-2218
US

IV. Provider business mailing address

4011 SW 29TH ST # 185
TOPEKA KS
66614-2218
US

V. Phone/Fax

Practice location:
  • Phone: 785-213-0470
  • Fax:
Mailing address:
  • Phone: 785-213-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2958412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: