Provider Demographics
NPI:1770297269
Name:MELTON, TRISHA L (RN)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:L
Last Name:MELTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17719 N BEACHSIDE DR SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-9375
Mailing Address - Country:US
Mailing Address - Phone:360-910-9164
Mailing Address - Fax:360-443-7570
Practice Address - Street 1:17719 N BEACHSIDE DR SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9375
Practice Address - Country:US
Practice Address - Phone:360-910-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61031587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse