Provider Demographics
NPI:1922187418
Name:ANDERSON, MELANIE JANINE (ARNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 SE 38TH ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6105
Mailing Address - Country:US
Mailing Address - Phone:425-890-8988
Mailing Address - Fax:425-637-1150
Practice Address - Street 1:12600 SE 38TH ST
Practice Address - Street 2:SUITE 235
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5232
Practice Address - Country:US
Practice Address - Phone:425-890-8988
Practice Address - Fax:425-637-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004847363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8115ANOtherREGENCE BLUE SHIELD PIN
WA60054OtherAETNA PIN
WA8115ANOtherREGENCE BLUE SHIELD PIN
WA8802790Medicare ID - Type Unspecified