Provider Demographics
NPI:1912978495
Name:KLOEPFER RICE, MELINDA (ARNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:KLOEPFER RICE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:KLOEPFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:17191 BOTHELL WAY NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-4250
Mailing Address - Country:US
Mailing Address - Phone:206-364-8272
Mailing Address - Fax:206-364-5418
Practice Address - Street 1:17191 BOTHELL WAY NE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-4250
Practice Address - Country:US
Practice Address - Phone:206-364-8272
Practice Address - Fax:206-364-5418
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9631193Medicaid
WAAB22100Medicare ID - Type Unspecified
WA9631193Medicaid