Healthcare Provider Details

I. General information

NPI: 1053760199
Provider Name (Legal Business Name): JOSEPH MELCHI DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LONDON AVE
MARYSVILLE OH
43040-1594
US

IV. Provider business mailing address

10760 MANGROVE LOOP
PLAIN CITY OH
43064-3540
US

V. Phone/Fax

Practice location:
  • Phone: 800-686-4677
  • Fax:
Mailing address:
  • Phone: 614-390-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024173606
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: