Healthcare Provider Details

I. General information

NPI: 1477417160
Provider Name (Legal Business Name): MELISSA LONEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 NE HANCOCK ST
PORTLAND OR
97212-3955
US

IV. Provider business mailing address

703 NE HANCOCK ST
PORTLAND OR
97212-3955
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-9875
  • Fax: 503-331-3441
Mailing address:
  • Phone: 503-230-9875
  • Fax: 503-331-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number113472
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: