Provider Demographics
NPI:1336411412
Name:RHYASEN, MELISSA JOHNSON (PA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JOHNSON
Last Name:RHYASEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16500 SE 15TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9665
Mailing Address - Country:US
Mailing Address - Phone:360-254-4402
Mailing Address - Fax:
Practice Address - Street 1:16500 SE 15TH ST
Practice Address - Street 2:STE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9665
Practice Address - Country:US
Practice Address - Phone:360-254-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOA-60420680363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical