Provider Demographics
NPI:1134160443
Name:MELVIN, R EVELYN (CRNA)
Entity type:Individual
Prefix:
First Name:R
Middle Name:EVELYN
Last Name:MELVIN
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:PO BOX 711841
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0001
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:304-720-8461
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:PLEASANT VALLEY HOSPITAL
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2031
Practice Address - Country:US
Practice Address - Phone:304-674-2403
Practice Address - Fax:304-675-2240
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25481367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721839OtherMSBCBS
WV27005299700OtherBRICKSTREET
WV270052997003OtherTRICARE
WVP00093008OtherRR MEDICARE
WV0207026000Medicaid
WV001706470OtherMSBCBS
WV0067762000Medicaid
WVDA0096OtherRR MEDICARE
OH0767424Medicaid
WV270052997003OtherTRICARE
WV0207026000Medicaid