Provider Demographics
NPI:1811162969
Name:QUISANO, MELISSA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:QUISANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 N JEFFERSON LN STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-7104
Mailing Address - Country:US
Mailing Address - Phone:509-625-3700
Mailing Address - Fax:509-625-3747
Practice Address - Street 1:546 N JEFFERSON LN STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7104
Practice Address - Country:US
Practice Address - Phone:509-625-3700
Practice Address - Fax:509-625-3747
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60041327207Q00000X
WAML20008758390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8567463Medicaid
WAMD 60041327OtherWASHINGTON STATE DEPARTMENT OF HEALTH