Provider Demographics
NPI:1326134842
Name:LAURITS-STOCEK, MELISA ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:ANNE
Last Name:LAURITS-STOCEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MELISA
Other - Middle Name:ANNE
Other - Last Name:LAURITS-STOCEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3550 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1196
Mailing Address - Country:US
Mailing Address - Phone:503-331-6440
Mailing Address - Fax:
Practice Address - Street 1:3550 N. INTERSTATE AVE.
Practice Address - Street 2:INTERSTATE MEDICAL OFFICE EAST
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1097
Practice Address - Country:US
Practice Address - Phone:503-331-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA 00917363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical