Provider Demographics
NPI:1861439184
Name:MONTELEONE, MELISSA M (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:MONTELEONE
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 1:19811 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5714
Mailing Address - Country:US
Mailing Address - Phone:586-226-9552
Mailing Address - Fax:
Practice Address - Street 1:19811 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5714
Practice Address - Country:US
Practice Address - Phone:586-226-9552
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704160940367500000X
FLARNP 9168163367500000X
CA3358367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM77150020Medicare PIN