Provider Demographics
NPI:1023733326
Name:UNDERWOOD, MELANIE ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ELIZABETH
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:
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 2940
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-2940
Mailing Address - Country:US
Mailing Address - Phone:360-979-0569
Mailing Address - Fax:
Practice Address - Street 1:1173 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1782
Practice Address - Country:US
Practice Address - Phone:360-979-0569
Practice Address - Fax:877-805-9505
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV860183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily