Healthcare Provider Details

I. General information

NPI: 1306130505
Provider Name (Legal Business Name): MELISSA ROACH DENISON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ROACH

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 S 336TH ST STE C
FEDERAL WAY WA
98003-6329
US

IV. Provider business mailing address

533 S 336TH ST STE C
FEDERAL WAY WA
98003-6329
US

V. Phone/Fax

Practice location:
  • Phone: 253-661-1700
  • Fax:
Mailing address:
  • Phone: 253-661-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP60225973
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: