Provider Demographics
NPI:1235135013
Name:POSO, MELINDA LEE (MN, ARNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEE
Last Name:POSO
Suffix:
Gender:F
Credentials:MN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99068
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-0068
Mailing Address - Country:US
Mailing Address - Phone:253-448-3686
Mailing Address - Fax:253-444-3822
Practice Address - Street 1:6425 NYANZA PARK DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-5237
Practice Address - Country:US
Practice Address - Phone:253-448-3686
Practice Address - Fax:253-444-3822
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-25
Last Update Date:2012-12-29
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
WAAP30005855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9633231Medicaid
WA9633231Medicaid
WAP49175Medicare UPIN