Individual
MRS. LAURA BLACKWELL MELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6122
(864) 560-6276
Mailing address
PO BOX 277723, ATLANTA, GA 30384-7723
(864) 560-4123
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95563
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
3577
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN1719
—
SC
01
—
P00691781
RR MEDICARE
SC
Enumeration date
02/19/2008
Last updated
11/18/2010
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