Provider Demographics
NPI:1740007061
Name:CRUMP, MELANIE WETZEL (CST)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:WETZEL
Last Name:CRUMP
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:MCGEHEE
Other - Last Name:CAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:515 READ ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1739
Mailing Address - Country:US
Mailing Address - Phone:812-424-9291
Mailing Address - Fax:812-421-2722
Practice Address - Street 1:4011 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8947
Practice Address - Country:US
Practice Address - Phone:812-424-9291
Practice Address - Fax:812-421-2722
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN186728246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant