Provider Demographics
NPI:1316018088
Name:CROUMIE HALL, MELISSA KAYE (FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAYE
Last Name:CROUMIE HALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEILSSA
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4835 HOEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 NUT TREE RD
Practice Address - Street 2:#140
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4166
Practice Address - Country:US
Practice Address - Phone:707-448-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily