Provider Demographics
NPI:1861657942
Name:MELE, THERESA L (RN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:L
Last Name:MELE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16971 MAPLE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5631
Mailing Address - Country:US
Mailing Address - Phone:503-635-7692
Mailing Address - Fax:
Practice Address - Street 1:16971 MAPLE CIR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-5631
Practice Address - Country:US
Practice Address - Phone:503-635-7692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081055235RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse