Provider Demographics
NPI:1477009702
Name:KOLNIK, MELISSA LYNN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LYNN
Last Name:KOLNIK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:YOUNGBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9632 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2320
Mailing Address - Country:US
Mailing Address - Phone:218-428-6393
Mailing Address - Fax:
Practice Address - Street 1:501 N NAVAJO DR
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-0959
Practice Address - Country:US
Practice Address - Phone:928-645-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA1223367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered