Provider Demographics
NPI:1164486239
Name:MELVIN, JULIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:MELVIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7150 CLEARVISTA DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1695
Practice Address - Country:US
Practice Address - Phone:317-621-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28109739A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164486239OtherNPI
IN200250060Medicaid
IN200250060Medicaid
1164486239OtherNPI
S65662Medicare UPIN
INM400025402Medicare PIN
CA9260AMedicare ID - Type Unspecified