Healthcare Provider Details

I. General information

NPI: 1881604924
Provider Name (Legal Business Name): DANA MELANCON PALO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58515 PEARL ACRES RD
SLIDELL LA
70461-5423
US

IV. Provider business mailing address

419 N TALLOWWOOD DR
COVINGTON LA
70433-6291
US

V. Phone/Fax

Practice location:
  • Phone: 985-641-8982
  • Fax:
Mailing address:
  • Phone: 504-473-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberAP04972
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04972
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: