Provider Demographics
NPI:1629439104
Name:GEROLIMATOS, MELISSA SUE (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:GEROLIMATOS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:MOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:416 GARDNER POINT DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28678-9039
Mailing Address - Country:US
Mailing Address - Phone:616-260-1803
Mailing Address - Fax:
Practice Address - Street 1:416 GARDNER POINT DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NC
Practice Address - Zip Code:28678-9039
Practice Address - Country:US
Practice Address - Phone:616-260-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306307367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered