Provider Demographics
NPI:1700050853
Name:COLLINS, MELANIE (LMP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15027 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6134
Mailing Address - Country:US
Mailing Address - Phone:206-362-3520
Mailing Address - Fax:206-362-3521
Practice Address - Street 1:15027 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6134
Practice Address - Country:US
Practice Address - Phone:206-362-3520
Practice Address - Fax:206-362-3521
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-19
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist