Provider Demographics
NPI:1710066477
Name:MELVILLE, JENNIFER LYNN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MADISON ST STE 1150
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3558
Mailing Address - Country:US
Mailing Address - Phone:206-386-3400
Mailing Address - Fax:206-386-3411
Practice Address - Street 1:1101 MADISON ST STE 1150
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3558
Practice Address - Country:US
Practice Address - Phone:206-386-3400
Practice Address - Fax:206-386-3411
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017057Medicaid
AB09233Medicare ID - Type Unspecified
WA8210445Medicaid
3579OtherINTERNAL ID-MOTOR VEHICLE ID
G92637Medicare UPIN