Provider Demographics
NPI:1922054535
Name:BEYFUSS, MELISSA BADAR (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BADAR
Last Name:BEYFUSS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BADAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46581-1296
Mailing Address - Country:US
Mailing Address - Phone:574-268-9640
Mailing Address - Fax:574-268-0684
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:574-268-9640
Practice Address - Fax:574-268-0684
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28106139A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00760810OtherMEDICARE RAILROAD
IN200308610Medicaid
IN000000670869OtherANTHEM
IN1922054535OtherANTHEM BLUE CROSS BLUE SHIELD
OH2009294Medicaid
IN1922054535OtherANTHEM BLUE CROSS BLUE SHIELD
INM400018473Medicare PIN