Healthcare Provider Details

I. General information

NPI: 1861457269
Provider Name (Legal Business Name): MELISSA N. SHOTKOSKI TUFFORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA NICOLE SHOTKOSKI CRNA

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N ERIE ST
LEXINGTON NE
68850-1571
US

IV. Provider business mailing address

PO BOX 980
LEXINGTON NE
68850-0980
US

V. Phone/Fax

Practice location:
  • Phone: 308-324-5651
  • Fax: 308-324-8359
Mailing address:
  • Phone: 308-324-5651
  • Fax: 308-324-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100954
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: