Provider Demographics
NPI:1588662480
Name:RAKESMITH, MELINDA S (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:S
Last Name:RAKESMITH
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 1:2637 E ATLANTIC BLVD
Mailing Address - Street 2:#39942
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4939
Mailing Address - Country:US
Mailing Address - Phone:419-410-5758
Mailing Address - Fax:
Practice Address - Street 1:2637 E ATLANTIC BLVD
Practice Address - Street 2:#39942
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4939
Practice Address - Country:US
Practice Address - Phone:419-410-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH254403367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH430065755OtherRAILROAD MEDICARE
MI104341115OtherMICHIGAN MEDICAID
OH2181508Medicaid
OH8226572Medicare ID - Type UnspecifiedOHIO MEDICARE
OH2181508Medicaid
OH8226573Medicare ID - Type UnspecifiedOHIO MEDICARE