Basic Information
| Provider Information | |||||||||
| NPI: | 1750331344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATCHISON | ||||||||
| FirstName: | MELVIN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6139, | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882700340 | ||||||||
| FaxNumber: | 8882700331 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 TRANCAS ST | ||||||||
| Address2: | QUEEN OF THE VALLY HOSPITAL | ||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072262901 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 01/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN419471 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | NA1156 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | RN4194710 | 05 | CA | MEDICAID |