Provider Demographics
NPI:1144411406
Name:D'HAENE, MELISSA A (LMP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:D'HAENE
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 1:119 N COMMERCIAL ST
Mailing Address - Street 2:STE 410
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4446
Mailing Address - Country:US
Mailing Address - Phone:360-990-6459
Mailing Address - Fax:360-718-9212
Practice Address - Street 1:119 N COMMERCIAL ST
Practice Address - Street 2:STE 410
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4446
Practice Address - Country:US
Practice Address - Phone:360-990-6459
Practice Address - Fax:360-718-9212
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023939174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0222445OtherLABOR AND INDUSTRIES