Provider Demographics
NPI:1609856244
Name:MELSON, CELESTE A (CRNA)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:A
Last Name:MELSON
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 1:6739 E HORNED OWL TRL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-8514
Mailing Address - Country:US
Mailing Address - Phone:480-563-1327
Mailing Address - Fax:
Practice Address - Street 1:6739 E HORNED OWL TRL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-8514
Practice Address - Country:US
Practice Address - Phone:480-563-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 105475367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ458986Medicaid
TX8G8657Medicare PIN
AZ26508Medicare ID - Type Unspecified
AZ458986Medicaid