Provider Demographics
NPI:1821010091
Name:BAXTER, MELISSA ANN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:BAXTER
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 1:921 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-7051
Mailing Address - Country:US
Mailing Address - Phone:650-521-2457
Mailing Address - Fax:650-966-1773
Practice Address - Street 1:921 YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-7051
Practice Address - Country:US
Practice Address - Phone:650-521-2457
Practice Address - Fax:650-966-1773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1975367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered