Provider Demographics
NPI:1689629222
Name:NEWELL, MELINDA J (FNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:NEWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13994
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-0994
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:1881 NW 185TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-6822
Practice Address - Country:US
Practice Address - Phone:503-216-9300
Practice Address - Fax:503-216-9339
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR086000065N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150146Medicaid
OR150146Medicaid
ORS49212Medicare UPIN