Healthcare Provider Details

I. General information

NPI: 1881757540
Provider Name (Legal Business Name): MELANIE ANN HENRIKSEN CNM, N.D., L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 NW FRAZIER CT
PORTLAND OR
97229-8487
US

IV. Provider business mailing address

1106 NW FRAZIER CT
PORTLAND OR
97229-8487
US

V. Phone/Fax

Practice location:
  • Phone: 503-740-4541
  • Fax:
Mailing address:
  • Phone: 503-740-4541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00942
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1423
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200743309RN
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number200950104NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: