Provider Demographics
NPI:1750331344
Name:ATCHISON, MELVIN LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:LEE
Last Name:ATCHISON
Suffix:
Gender:M
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:PO BOX 6139,
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94581
Mailing Address - Country:US
Mailing Address - Phone:888-270-0340
Mailing Address - Fax:888-270-0331
Practice Address - Street 1:1000 TRANCAS ST
Practice Address - Street 2:QUEEN OF THE VALLY HOSPITAL
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-226-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN419471367500000X
CANA1156367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN4194710Medicaid
CARN4194710Medicaid
CAZZZ28011ZMedicare ID - Type Unspecified