Provider Demographics
NPI:1073588166
Name:CUNNINGHAM, MELANIE JOY (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:JOY
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 E PITTSBURGH ST # 338
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2781
Mailing Address - Country:US
Mailing Address - Phone:412-558-0950
Mailing Address - Fax:
Practice Address - Street 1:645 E PITTSBURGH ST # 338
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2781
Practice Address - Country:US
Practice Address - Phone:412-558-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246678367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4701327Medicaid
MI4701327Medicaid