Provider Demographics
NPI:1205865144
Name:STONESTREET, MELODY L (CRNA)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:L
Last Name:STONESTREET
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:PO BOX 711841
Mailing Address - Street 2:MID -ATLANTIC ANESTHESIA CONSULTANTS
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0001
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:304-720-8461
Practice Address - Street 1:1400 HOSPITAL DR
Practice Address - Street 2:PUTNAM GENERAL HOSPITAL
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526
Practice Address - Country:US
Practice Address - Phone:304-757-1797
Practice Address - Fax:304-757-1717
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV27005299700OtherBRICKSTREET
WV001706470OtherMSBCBS GROUP
WV001706470OtherMSBCBS
WV001713624OtherBCBS
WV0066794000Medicaid
WV0207026000Medicaid
WVP00001157OtherRR MEDICARE
WV270052997002OtherTRICARE
WVDA0096OtherRR MEDICARE
WV27005299700OtherBRICKSTREET
WV8222972Medicare PIN
WV$$$$$$$$$00OtherTRICARE