Healthcare Provider Details

I. General information

NPI: 1437547379
Provider Name (Legal Business Name): MELISSA MARIE HUDZIK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 KNOLLWOOD AVE
POLAND OH
44514-1525
US

IV. Provider business mailing address

2343 KNOLLWOOD AVE
POLAND OH
44514-1525
US

V. Phone/Fax

Practice location:
  • Phone: 330-774-3505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA-19085
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: