Healthcare Provider Details

I. General information

NPI: 1588659874
Provider Name (Legal Business Name): MELANIE JUNEQ WOOD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER
FT LEWIS WA
98433
US

IV. Provider business mailing address

505 S 336TH ST SUITE 600
FEDERAL WAY WA
98003-6328
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2626
  • Fax:
Mailing address:
  • Phone: 253-838-6180
  • Fax: 253-838-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10001997
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: