Provider Demographics
NPI:1134603038
Name:BLAGDEN, MELISSA (RN, RNFA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BLAGDEN
Suffix:
Gender:F
Credentials:RN, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12180 SW MERESTONE CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-3168
Mailing Address - Country:US
Mailing Address - Phone:971-645-8288
Mailing Address - Fax:
Practice Address - Street 1:12180 SW MERESTONE COURT
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-9722
Practice Address - Country:US
Practice Address - Phone:971-645-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201143298RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant