Healthcare Provider Details

I. General information

NPI: 1144009119
Provider Name (Legal Business Name): MELISSA PORTNOY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA ESTRADA-ELENA ARNP

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 FOUNDERS WAY
FORKS WA
98331-9062
US

IV. Provider business mailing address

530 BOGACHIEL WAY
FORKS WA
98331-9120
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-6998
  • Fax: 360-374-3162
Mailing address:
  • Phone: 360-374-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN60565637
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61499144
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: