Healthcare Provider Details

I. General information

NPI: 1386822658
Provider Name (Legal Business Name): MS. MELISSA HAYS MONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N HIGHWAY 101 STE 210
WARRENTON OR
97146
US

IV. Provider business mailing address

1790 E 11TH AVENUE SUITE 290
EUGENE OR
97402-3759
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-5722
  • Fax:
Mailing address:
  • Phone: 541-686-1262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: