Healthcare Provider Details

I. General information

NPI: 1063471852
Provider Name (Legal Business Name): FRANCESCA T MELLE PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SW ARROW
WALDPORT OR
97394
US

IV. Provider business mailing address

150 SW ARROW
WALDPORT OR
97394
US

V. Phone/Fax

Practice location:
  • Phone: 541-536-3197
  • Fax: 541-536-3198
Mailing address:
  • Phone: 541-536-3197
  • Fax: 541-536-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA169805
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: