Healthcare Provider Details

I. General information

NPI: 1114004488
Provider Name (Legal Business Name): MELANI M PENE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

IV. Provider business mailing address

PO BOX 626
BIDDEFORD ME
04005-0626
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-7040
  • Fax: 207-283-7850
Mailing address:
  • Phone: 207-283-7040
  • Fax: 207-283-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR047915
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: