Provider Demographics
NPI:1790142313
Name:POWELL, MELONIE (BSN)
Entity Type:Individual
Prefix:
First Name:MELONIE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 NE 67TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1852
Mailing Address - Country:US
Mailing Address - Phone:503-490-5536
Mailing Address - Fax:
Practice Address - Street 1:3655 NE GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2094
Practice Address - Country:US
Practice Address - Phone:503-335-0855
Practice Address - Fax:503-335-8125
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200743407RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse