Provider Demographics
NPI:1285028308
Name:RENDER, MELISSA KATE (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATE
Last Name:RENDER
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 1:332 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1636
Mailing Address - Country:US
Mailing Address - Phone:618-416-6332
Mailing Address - Fax:
Practice Address - Street 1:5921 MERIDIAN WOODS
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1545
Practice Address - Country:US
Practice Address - Phone:314-753-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012608367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered