Provider Demographics
NPI:1295353464
Name:MELNIK, EKATERINA (NP)
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:MELNIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATYA
Other - Middle Name:
Other - Last Name:MELNIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:916 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-4324
Mailing Address - Country:US
Mailing Address - Phone:360-336-5658
Mailing Address - Fax:360-336-5655
Practice Address - Street 1:916 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4324
Practice Address - Country:US
Practice Address - Phone:360-336-5658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61081980363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2184217Medicaid