Provider Demographics
NPI:1255571816
Name:PANCHAL, MELANIE M (ACNP-BC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:M
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:M
Other - Last Name:MORGIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11017 BARTLETT AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5828
Mailing Address - Country:US
Mailing Address - Phone:630-854-6563
Mailing Address - Fax:
Practice Address - Street 1:1145 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4201
Practice Address - Country:US
Practice Address - Phone:206-860-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2009001031363LA2100X
WAAP60145026363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care