Healthcare Provider Details

I. General information

NPI: 1427297704
Provider Name (Legal Business Name): MELISSA KAY LUCENTA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 JOHNSON RD
STEUBENVILLE OH
43952-2364
US

IV. Provider business mailing address

214 WILSHIRE BLVD
STEUBENVILLE OH
43952-1165
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-8329
  • Fax:
Mailing address:
  • Phone: 740-266-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.10601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: