Provider Demographics
NPI:1700096609
Name:HALLER, MELANIE ANNE (RNFA)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ANNE
Last Name:HALLER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 KROMER AVE APT D
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4187
Mailing Address - Country:US
Mailing Address - Phone:425-258-9278
Mailing Address - Fax:
Practice Address - Street 1:3041 KROMER AVE APT D
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4187
Practice Address - Country:US
Practice Address - Phone:425-258-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00087922163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007996216OtherAETNA
PREMERA BLUE CROSSOther211217100000
QMXPR0061572OtherMOLINA
PR21112990001OtherCIGNA
WA9627563Medicaid
WA1109037OtherCOMMUNITY HEALTH
209629000001OtherPHP-PROVIDENCE EMPLOYEES
211217100000OtherPREMERA BLUE CROSS