Provider Demographics
NPI:1497006738
Name:ROBERTSON, MELANIE J (RN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-1631
Mailing Address - Country:US
Mailing Address - Phone:360-538-8288
Mailing Address - Fax:360-538-8222
Practice Address - Street 1:200 SPENCER ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-1631
Practice Address - Country:US
Practice Address - Phone:360-538-8288
Practice Address - Fax:360-538-8222
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00159936163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool