Provider Demographics
NPI:1356495162
Name:CAIN, MELANIE LARAE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:LARAE
Last Name:CAIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-4326
Mailing Address - Country:US
Mailing Address - Phone:509-308-5561
Mailing Address - Fax:509-783-6675
Practice Address - Street 1:3180 W CLEARWATER AVE
Practice Address - Street 2:STE F
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2767
Practice Address - Country:US
Practice Address - Phone:509-308-5561
Practice Address - Fax:509-783-6675
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021675225700000X
WA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0203726Medicare UPIN
WA3055CAMedicare UPIN