Provider Demographics
NPI:1518067214
Name:SOUSLEY, MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:SOUSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19408 NORTH LITTLE SPOKANE RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005
Mailing Address - Country:US
Mailing Address - Phone:509-953-4299
Mailing Address - Fax:
Practice Address - Street 1:GROUP HEALTH COOPERATIVE, LIDGERWOOD CENTER
Practice Address - Street 2:N.6002 LIDGERWOOD
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-482-4402
Practice Address - Fax:509-482-5071
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA015866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine