Provider Demographics
NPI:1366484602
Name:SALAZAR, MELISSA JOY (PAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOY
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JOY
Other - Last Name:BILDERBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:445 HARLOW RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1346
Mailing Address - Country:US
Mailing Address - Phone:360-733-0430
Mailing Address - Fax:541-334-7560
Practice Address - Street 1:445 HARLOW RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1346
Practice Address - Country:US
Practice Address - Phone:360-733-0430
Practice Address - Fax:541-334-7560
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA157434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8859450Medicare ID - Type Unspecified
Q66933Medicare UPIN