Provider Demographics
NPI:1679850192
Name:LEWIS, MELISSA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 15TH AVE W
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3821
Mailing Address - Country:US
Mailing Address - Phone:701-774-7401
Mailing Address - Fax:701-774-7479
Practice Address - Street 1:1301 15TH AVE W
Practice Address - Street 2:ADMINISTRATION
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3821
Practice Address - Country:US
Practice Address - Phone:701-774-7401
Practice Address - Fax:701-774-7479
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDR36966367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered