Provider Demographics
NPI:1760708978
Name:NELSON, MELISSA SELICA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SELICA
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:SELICA
Other - Last Name:GRENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3800 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-9146
Mailing Address - Country:US
Mailing Address - Phone:360-421-3837
Mailing Address - Fax:360-657-4103
Practice Address - Street 1:8821 51ST AVE NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2605
Practice Address - Country:US
Practice Address - Phone:360-653-3140
Practice Address - Fax:360-657-4103
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60145632225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist