Provider Demographics
NPI:1881604924
Name:PALO, DANA MELANCON (CRNA)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MELANCON
Last Name:PALO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N TALLOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6291
Mailing Address - Country:US
Mailing Address - Phone:504-473-3262
Mailing Address - Fax:
Practice Address - Street 1:58515 PEARL ACRES RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5423
Practice Address - Country:US
Practice Address - Phone:985-641-8982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04972225XL0004X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1583049Medicaid
LAAP04972OtherADVANCED PRACTICE LICENSE
MS02930323Medicaid
LA101720OtherRN LICENSE
LAAP04972OtherADVANCED PRACTICE LICENSE
LA3A010CT28Medicare PIN
LA3A010Medicare PIN