Provider Demographics
NPI:1164899316
Name:SPENCER, MELISSA J (ARNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14410 SE PETROVITSKY RD STE 209
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8900
Mailing Address - Country:US
Mailing Address - Phone:425-578-9505
Mailing Address - Fax:425-207-4967
Practice Address - Street 1:14410 SE PETROVITSKY RD STE 209
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-8900
Practice Address - Country:US
Practice Address - Phone:425-578-9505
Practice Address - Fax:425-578-9505
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7421827-4405363LP0808X
WAAP60920612363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health