Provider Demographics
NPI:1881604924
Name:PALO, DANA MELANCON (CRNA)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MELANCON
Last Name:PALO
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 1:419 N TALLOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6291
Mailing Address - Country:US
Mailing Address - Phone:504-473-3262
Mailing Address - Fax:
Practice Address - Street 1:58515 PEARL ACRES RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5423
Practice Address - Country:US
Practice Address - Phone:985-641-8982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04972367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA101720OtherRN LICENSE
LA1583049Medicaid
LAAP04972OtherADVANCED PRACTICE LICENSE
MS02930323Medicaid
LAAP04972OtherADVANCED PRACTICE LICENSE
LA3A010CT28Medicare PIN
LA3A010Medicare PIN