Melissa Green, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Lakeside, AZ
NPI 1144258989 · NPPES record last updated Nov 2, 2011
Key facts
- NPI
- 1144258989
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- RN156511 (AZ)
- Practice address
- 5080 Mogollon Rim Dr
Lakeside, AZ 85929-5530 - Phone
- (480) 297-5926
- NPI assigned
- Jun 29, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090311000690 | AZ | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 9436100989 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN156511 | AZ | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeastern Anesthesia PLLC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Anesthesia Associates of Savannah ,PA | Past | Accepting new patients | |
| Northern Indiana Anesthesia Services, P.C. | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Locations
2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-4375
5700 E Highway 90
Sierra Vista, AZ 85635
Phone (520) 263-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN156511 | AZ | Yes |
Addresses
Primary practice location
5080 Mogollon Rim Dr
Lakeside, AZ 85929-5530
Mailing address
5080 Mogollon Rim Dr
Lakeside, AZ 85929-5530
Phone (480) 297-5926
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z142693 | Other | AZ | MEDICARE PROVIDER |
| 200513500 | Medicaid | IN |
Other names
- Melissa Kemper
Other providers in Lakeside, AZ
- Mark Mitchell Garskof
- Gaylon E Crawford DO Inc
- Patrick Adam Goodman
- Anthony Daniel Greco
- Chance Green
- Hall Family Practice PLLC
- Hugh Ryan Hall
- Karen Olsen Hall
- Nanette Hall
- Jacqueline Susan Harte
All providers in Lakeside, AZ · Certified Registered Nurse Anesthetist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.