Healthcare Provider Details

I. General information

NPI: 1104649474
Provider Name (Legal Business Name): MELISSA PORRAS CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 NW LOUISIANA AVE
BEND OR
97703-3310
US

IV. Provider business mailing address

1699 NW HARTFORD AVE
BEND OR
97703-2453
US

V. Phone/Fax

Practice location:
  • Phone: 415-730-8686
  • Fax:
Mailing address:
  • Phone: 415-730-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number201709704RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: