1043640030 NPI number — MRS. MELISSA FOX HENRY CRNA, DNAP

Table of content: ANNIE DOUGLAS (NPI 1548768872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043640030 NPI number — MRS. MELISSA FOX HENRY CRNA, DNAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
MELISSA
Provider Middle Name:
FOX
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA, DNAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043640030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 PONSBURY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-2690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-863-8208
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 ASHLEY AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF NURSE ANESTHESIA
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-8908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-2322
Provider Business Practice Location Address Fax Number:
843-792-9314
Provider Enumeration Date:
11/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  18515 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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