Provider Demographics
NPI:1336331180
Name:DISTEFANO DITTA, MELANIE (CRNA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:DISTEFANO DITTA
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 1:3510 N CAUSEWAY BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3531
Mailing Address - Country:US
Mailing Address - Phone:504-779-5515
Mailing Address - Fax:504-779-5568
Practice Address - Street 1:3510 N CAUSEWAY BLVD STE 404
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3531
Practice Address - Country:US
Practice Address - Phone:504-779-5515
Practice Address - Fax:504-779-5568
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered