Healthcare Provider Details

I. General information

NPI: 1124905815
Provider Name (Legal Business Name): MELISSA ANNE YASSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2025
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NE DIVISION ST
GRESHAM OR
97030-4617
US

IV. Provider business mailing address

14680 SW 120TH PL
TIGARD OR
97224-2745
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-6575
  • Fax:
Mailing address:
  • Phone: 971-409-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60468327
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: