Provider Demographics
NPI:1518112366
Name:LOUTHAIN, MELISSA DAWN (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:LOUTHAIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:14124 PHINNEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6847
Mailing Address - Country:US
Mailing Address - Phone:858-519-8133
Mailing Address - Fax:
Practice Address - Street 1:915 118TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3875
Practice Address - Country:US
Practice Address - Phone:206-704-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006801363LA2200X
INA0608358363LA2200X
WAAP61028239363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400041548Medicare PIN
INM400022614Medicare PIN
IN256450IMedicare PIN
INM400022631Medicare PIN
IN203960B1Medicare PIN