Provider Demographics
NPI:1245332634
Name:MELLEN, REGINA M (CRNA)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:M
Last Name:MELLEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 3456
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-3456
Mailing Address - Country:US
Mailing Address - Phone:918-333-4100
Mailing Address - Fax:918-333-4106
Practice Address - Street 1:JPMC ANESTHESIA DEPARTMENT
Practice Address - Street 2:3500 EAST FRANK PHILLIPS BLVD
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2411
Practice Address - Country:US
Practice Address - Phone:918-331-1555
Practice Address - Fax:918-331-1695
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0067269367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200025940AMedicaid
OK200025940AMedicaid