Provider Demographics
NPI:1881757540
Name:HENRIKSEN, MELANIE ANN (CNM, ND, LAC)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ANN
Last Name:HENRIKSEN
Suffix:
Gender:F
Credentials:CNM, ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 NW FRAZIER CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8487
Mailing Address - Country:US
Mailing Address - Phone:503-740-4541
Mailing Address - Fax:
Practice Address - Street 1:1106 NW FRAZIER CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-8487
Practice Address - Country:US
Practice Address - Phone:503-740-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00942171100000X
OR1423175F00000X
OR200743309RN163W00000X
OR200950104NP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath
No163W00000XNursing Service ProvidersRegistered Nurse