Healthcare Provider Details

I. General information

NPI: 1699789206
Provider Name (Legal Business Name): MELISSA FOWLER ESCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA F LITTLEJOHN CRNA

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SKYLYN DR
SPARTANBURG SC
29307
US

IV. Provider business mailing address

PO BOX 102480
ATLANTA GA
30368-2480
US

V. Phone/Fax

Practice location:
  • Phone: 864-573-3000
  • Fax:
Mailing address:
  • Phone: 864-591-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2935
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: