Provider Demographics
NPI:1598264418
Name:BROOKE, MELISSA LILA (CRNA, RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LILA
Last Name:BROOKE
Suffix:
Gender:F
Credentials:CRNA, RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LILA
Other - Last Name:READY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:583 BATTERY ST APT 714
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1968
Mailing Address - Country:US
Mailing Address - Phone:509-499-1280
Mailing Address - Fax:
Practice Address - Street 1:2202 S CEDAR ST STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2318
Practice Address - Country:US
Practice Address - Phone:253-215-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60239096163W00000X
WAAP60833314367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60833314OtherWASHINGTON STATE DEPARTMENT OF HEALTH