Healthcare Provider Details

I. General information

NPI: 1134160443
Provider Name (Legal Business Name): R EVELYN MELVIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 VALLEY DR PLEASANT VALLEY HOSPITAL
POINT PLEASANT WV
25550-2031
US

IV. Provider business mailing address

PO BOX 711841
COLUMBUS OH
43271-0001
US

V. Phone/Fax

Practice location:
  • Phone: 304-674-2403
  • Fax: 304-675-2240
Mailing address:
  • Phone: 304-346-9400
  • Fax: 304-720-8461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number25481
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: