Healthcare Provider Details

I. General information

NPI: 1174978340
Provider Name (Legal Business Name): MELISSA BEA LINDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 SE NAEF RD #G20
MILWAUKIE OR
97267-4902
US

IV. Provider business mailing address

4400 SE NAEF RD #G20
MILWAUKIE OR
97267-4902
US

V. Phone/Fax

Practice location:
  • Phone: 503-349-9887
  • Fax:
Mailing address:
  • Phone: 503-349-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: