Provider Demographics
NPI:1669434031
Name:THROCKMORTON, MELANIE JEANNE (ARNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JEANNE
Last Name:THROCKMORTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1832
Mailing Address - Country:US
Mailing Address - Phone:425-750-3139
Mailing Address - Fax:
Practice Address - Street 1:4120 MERIDIAN ST STE 220
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5575
Practice Address - Country:US
Practice Address - Phone:360-922-3030
Practice Address - Fax:360-306-8374
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00065125163W00000X
WAAP3002175363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30002175OtherARNP LICENSE
0328358-21OtherANCC CERTIFICATION # AS A
WARN00065125OtherRN LICENSE
WA9625443Medicaid
WARN00065125OtherRN LICENSE