Basic Information
| Provider Information | |||||||||
| NPI: | 1831357961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VETICA | ||||||||
| FirstName: | MELODY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 LYTTON RD | ||||||||
| Address2: | |||||||||
| City: | MOON TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151081012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122622128 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 DUTCH RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150099727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247734621 | ||||||||
| FaxNumber: | 7247734696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2008 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 299721L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.