Healthcare Provider Details

I. General information

NPI: 1194784033
Provider Name (Legal Business Name): MELISSA MAE MITCHELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MITCHELL BAYNES

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARKER DR
FLORENCE SC
29501-6059
US

IV. Provider business mailing address

1011 S HANOVER RD
FLORENCE SC
29501-6061
US

V. Phone/Fax

Practice location:
  • Phone: 843-679-3251
  • Fax:
Mailing address:
  • Phone: 843-621-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN1753
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: