Provider Demographics
NPI:1861410516
Name:CAMPBELL, MELISSA ANN (CRNA)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:9030 N PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1346
Mailing Address - Country:US
Mailing Address - Phone:330-467-4166
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207402367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000234668OtherUNISON
OH0953875Medicaid
OH000000558050OtherANTHEM
OH9325141OtherATENA
OHP00673452OtherMEDICARE RAILROAD
OH0583328OtherBCMH
OH0953875Medicaid