Healthcare Provider Details

I. General information

NPI: 1780559898
Provider Name (Legal Business Name): MELYSSA GLEED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/24/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SUNSET DR
LA GRANDE OR
97850-1387
US

IV. Provider business mailing address

378 N MAIN ST # 141
LAYTON UT
84041-7102
US

V. Phone/Fax

Practice location:
  • Phone: 541-963-8421
  • Fax:
Mailing address:
  • Phone: 801-300-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10049108
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: