Provider Demographics
NPI:1275532376
Name:ISHMAN, MELVA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:MELVA
Middle Name:JEAN
Last Name:ISHMAN
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 1:423 N 21ST ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2207
Mailing Address - Country:US
Mailing Address - Phone:717-975-2430
Mailing Address - Fax:717-730-2158
Practice Address - Street 1:423 N 21ST ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2207
Practice Address - Country:US
Practice Address - Phone:717-975-2430
Practice Address - Fax:717-730-2158
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030168367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1312416OtherCAPITAL BLUE CROSS
PA1312416OtherHIGHMARK BLUE SHIELD
PAS32893OtherHEALTHAMERICA
PA1312416OtherHIGHMARK BLUE SHIELD