Provider Demographics
NPI:1982477683
Name:GRAHAM, MELISSA LEA (CNM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7295 SE TRUMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-7159
Mailing Address - Country:US
Mailing Address - Phone:253-226-8765
Mailing Address - Fax:
Practice Address - Street 1:3920 CAPITAL MALL DR SW STE 400
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8703
Practice Address - Country:US
Practice Address - Phone:360-705-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61408549367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife