Provider Demographics
NPI:1710766795
Name:LOUGH, MELODY ROSE (ACPCNP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ROSE
Last Name:LOUGH
Suffix:
Gender:F
Credentials:ACPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD STE 638
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6633
Mailing Address - Country:US
Mailing Address - Phone:503-216-7000
Mailing Address - Fax:
Practice Address - Street 1:9155 SW BARNES RD STE 638
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6633
Practice Address - Country:US
Practice Address - Phone:503-216-7000
Practice Address - Fax:503-216-6999
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10016532363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health