Healthcare Provider Details

I. General information

NPI: 1912675729
Provider Name (Legal Business Name): MELINDA PILAR ANELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SE LAKE RD
PORTLAND OR
97222-2129
US

IV. Provider business mailing address

14212 SE RUPERT DR
MILWAUKIE OR
97267-1204
US

V. Phone/Fax

Practice location:
  • Phone: 503-447-3285
  • Fax:
Mailing address:
  • Phone: 503-206-2435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10008344
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: