Healthcare Provider Details

I. General information

NPI: 1841262524
Provider Name (Legal Business Name): MELINDA SPOLSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8495 CRATER LAKE HWY
WHITE CITY OR
97503-3011
US

IV. Provider business mailing address

8495 CRATER LAKE HWY
WHITE CITY OR
97503-3011
US

V. Phone/Fax

Practice location:
  • Phone: 541-826-2111
  • Fax: 541-830-3535
Mailing address:
  • Phone: 541-826-2111
  • Fax: 541-830-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number098006589N1 FNP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: