Basic Information
| Provider Information | |||||||||
| NPI: | 1871562397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIG | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5059 | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378315059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006116713 | ||||||||
| FaxNumber: | 7702371124 | ||||||||
| Practice Location | |||||||||
| Address1: | 990 OAK RIDGE TPKE | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654811112 | ||||||||
| FaxNumber: | 7702371124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 103590 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 103590 | 01 | TN | NURSING LICENSE NUMBER | OTHER |