Doctor Name: | MELISSA SUE ANDERSON |
NPI Number: | 1144521170 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA001242 |
Business Practice Address: | 1000 Wallace Way Grandview, WA - 989308805 |
Business Phone Number: | 5098824275 |
Business Fax Number: | 5096853148 |
Mailing Address: | 518 W 1st Ave, Po Box 190 TOPPENISH |
State: | WA |
Postal Code: | 989481564 |
Phone Number: | 5098655898 |
Fax Number: | 5098653148 |
NPI Enumeration Date: | 11/08/2010 |
NPI Last Update Date: | 08/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA001242 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ME |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |