Provider Demographics
NPI:1295037679
Name:MORGAN, MELISSA (IBCLC, RLC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:IBCLC, RLC
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 1027
Mailing Address - Street 2:
Mailing Address - City:NEWMAN LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99025-1027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11811 N WEST NEWMAN LAKE DR
Practice Address - Street 2:
Practice Address - City:NEWMAN LAKE
Practice Address - State:WA
Practice Address - Zip Code:99025-8661
Practice Address - Country:US
Practice Address - Phone:509-228-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist