Provider Demographics
NPI:1083786297
Name:MELNICENCO, MARINA (LMP)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:MELNICENCO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19721 SCRIBER LAKE RD
Mailing Address - Street 2:# D
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6119
Mailing Address - Country:US
Mailing Address - Phone:425-775-3544
Mailing Address - Fax:425-670-6502
Practice Address - Street 1:19721 SCRIBER LAKE RD
Practice Address - Street 2:# D
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6119
Practice Address - Country:US
Practice Address - Phone:425-775-3544
Practice Address - Fax:425-670-6502
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020532225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist