Provider Demographics
NPI:1205803822
Name:COOK, MELISSA DAWN (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:HEUBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:412 NE FORD ST.
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:503-434-7525
Mailing Address - Fax:503-472-9731
Practice Address - Street 1:412 NE FORD ST.
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-434-7525
Practice Address - Fax:503-472-9731
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450103NPFNPPP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275433Medicaid
Q61444Medicare UPIN
OR133723Medicare ID - Type Unspecified