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General NPI Number Information
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NPI Number | 1134573090
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Entity Type | Organization
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Legal Business Name | REGINA M MELLEN PLLC
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 6262 S SHERIDAN RD
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City | TULSA
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State | OK
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Zip | 74133-4055
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Country | US
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Telephone | 800-821-6993
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 388
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City | NEWTON
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State | KS
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Zip | 67114-0388
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REGINA MELLEN
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Credential | CRNA
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Telephone | 800-821-6993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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