Provider Demographics
NPI:1952577280
Name:MERRISS, MELANIE ANNE (PMHNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNE
Last Name:MERRISS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SW COLORADO AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1150
Mailing Address - Country:US
Mailing Address - Phone:541-390-3720
Mailing Address - Fax:
Practice Address - Street 1:15 SW COLORADO AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1150
Practice Address - Country:US
Practice Address - Phone:541-390-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750115NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health