Provider Demographics
NPI:1013298033
Name:AKIN, MELISSA D (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:AKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:932 W IDAHO AVE
Practice Address - Street 2:STE 100
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2155
Practice Address - Country:US
Practice Address - Phone:541-889-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-03
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNP1081A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care