Individual
MELISSA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5080 MOGOLLON RIM DR, LAKESIDE, AZ 85929-5530
(480) 297-5926
Mailing address
5080 MOGOLLON RIM DR, LAKESIDE, AZ 85929-5530
(480) 297-5926
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN156511
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200513500
—
IN
01
—
Z142693
MEDICARE PROVIDER
AZ
Enumeration date
06/29/2006
Last updated
11/02/2011
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