Provider Demographics
NPI:1003193632
Name:HARTLEY, MELANIE R (ARNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:COOK-HARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-738-2200
Mailing Address - Fax:360-752-5679
Practice Address - Street 1:4545 CORDATA PKWY
Practice Address - Street 2:SUITE 1E
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7123
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-752-5679
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60231193363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0287627OtherL&I AND CRIME VICTIMS
WA1003193632OtherREGENCE BLUE SHIELD
WA1003193632Medicaid
WA1003193632OtherTRI WEST (TRICARE)
WAG8906106Medicare PIN