Provider Demographics
NPI:1508202060
Name:COLLORD, MELISSA S (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:COLLORD
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 1:16505 SE 1ST ST
Mailing Address - Street 2:SUITE A PMB 335
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-9586
Mailing Address - Country:US
Mailing Address - Phone:971-570-0221
Mailing Address - Fax:866-819-1380
Practice Address - Street 1:16505 SE 1ST ST
Practice Address - Street 2:SUITE A PMB 335
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-9586
Practice Address - Country:US
Practice Address - Phone:971-570-0221
Practice Address - Fax:866-819-1380
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60077103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse