Provider Demographics
NPI:1679729743
Name:HENSLEY, MELINDA (CRNA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:HENSLEY
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 1:9698 PATRIOT BLVD APT 132
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-8506
Mailing Address - Country:US
Mailing Address - Phone:843-952-3445
Mailing Address - Fax:
Practice Address - Street 1:9698 PATRIOT BLVD APT 132
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-8506
Practice Address - Country:US
Practice Address - Phone:843-952-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31483367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered