Basic Information
| Provider Information | |||||||||
| NPI: | 1073542213 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | M. ATCHISON CRNA INC, A PROFESSIONAL NURSING CORP. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6139 | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945811139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882700340 | ||||||||
| FaxNumber: | 8882700331 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 TRANCAS ST | ||||||||
| Address2: | QUEEN OF THE VALLEY HOSPITAL | ||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072282901 | ||||||||
| FaxNumber: | 7072563508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 05/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | ATCHISON | ||||||||
| AuthorizedOfficialFirstName: | MELVIN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8666403005 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1156 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | RN4194710 | 05 | CA | MEDICAID |