Provider Demographics
NPI:1558546911
Name:WINDROW, MELODY D (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:MELODY
Middle Name:D
Last Name:WINDROW
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-777-4870
Mailing Address - Fax:414-777-0033
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-777-4870
Practice Address - Fax:414-777-0033
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA1032367500000X
TNAPN13006367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3600207Medicaid
KY7100032250Medicaid
AL009913763Medicaid
TN4171076OtherBCBS
TN103I437738Medicare PIN
TN3600207Medicare PIN