Provider Demographics
NPI:1740556778
Name:NIELSEN, MELISSA DANIELLE (LMP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DANIELLE
Last Name:NIELSEN
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 1:16714 SMOKEY POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8410
Mailing Address - Country:US
Mailing Address - Phone:360-659-3044
Mailing Address - Fax:360-659-8464
Practice Address - Street 1:16714 SMOKEY POINT BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8410
Practice Address - Country:US
Practice Address - Phone:360-659-3044
Practice Address - Fax:360-659-8464
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60271630225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist