Provider Demographics
NPI:1992850135
Name:BURTNER, MELISSA G (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:BURTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-1008
Mailing Address - Country:US
Mailing Address - Phone:360-413-8413
Mailing Address - Fax:360-413-8879
Practice Address - Street 1:615 LILLY RD NE
Practice Address - Street 2:STE 200
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5117
Practice Address - Country:US
Practice Address - Phone:360-413-8413
Practice Address - Fax:360-413-8879
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042124207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8362568Medicaid
WAH75194Medicare UPIN
WAAB38282Medicare ID - Type Unspecified