Provider Demographics
NPI:1497790315
Name:LEAR-KONOLD, MELINDA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:LEAR-KONOLD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 7TH AVE SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1997
Mailing Address - Country:US
Mailing Address - Phone:541-967-4249
Mailing Address - Fax:541-928-2942
Practice Address - Street 1:1086 7TH AVE SW
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1997
Practice Address - Country:US
Practice Address - Phone:541-967-4249
Practice Address - Fax:541-928-2942
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR94006025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS76482Medicare UPIN