Provider Demographics
NPI:1144228115
Name:CUNDY-MELZER, PAULETTE L (CRNA)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:L
Last Name:CUNDY-MELZER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:L
Other - Last Name:CUNDY MELZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:40 TIMBERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9603
Mailing Address - Country:US
Mailing Address - Phone:513-300-2612
Mailing Address - Fax:
Practice Address - Street 1:40 TIMBERWOOD CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9603
Practice Address - Country:US
Practice Address - Phone:513-300-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH228993367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2333773Medicaid
OHCU8229851Medicare ID - Type Unspecified