Provider Demographics
NPI:1861457269
Name:TUFFORD, MELISSA N SHOTKOSKI (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:N SHOTKOSKI
Last Name:TUFFORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:NICOLE
Other - Last Name:SHOTKOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-0980
Mailing Address - Country:US
Mailing Address - Phone:308-324-5651
Mailing Address - Fax:308-324-8359
Practice Address - Street 1:1201 N ERIE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1571
Practice Address - Country:US
Practice Address - Phone:308-324-5651
Practice Address - Fax:308-324-8359
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100954367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47061979815Medicaid
NE086999005Medicare PIN