Provider Demographics
NPI:1568539989
Name:HANSES, MELISSA L (ARNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:HANSES
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 1:501 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3550
Mailing Address - Country:US
Mailing Address - Phone:509-494-6700
Mailing Address - Fax:509-573-6275
Practice Address - Street 1:314 S 11TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3212
Practice Address - Country:US
Practice Address - Phone:509-575-0114
Practice Address - Fax:509-575-0808
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005783363LP0200X
WARN00139188363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9632795Medicaid
WA0239425OtherL&I
WA9632795Medicaid
WAAB38059Medicare Oscar/Certification