Basic Information
| Provider Information | |||||||||
| NPI: | 1265044747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | MELYSSA | ||||||||
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| Credential: | BSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7408 SCOTIA RD | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991568550 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 W 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094743131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2020 | ||||||||
| LastUpdateDate: | 12/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | RN60945219 | WA | Y | Nursing Service Providers | Registered Nurse | Pediatrics |
No ID Information.