Healthcare Provider Details

I. General information

NPI: 1295037679
Provider Name (Legal Business Name): MELISSA MORGAN IBCLC, RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 N WEST NEWMAN LAKE DR
NEWMAN LAKE WA
99025-8661
US

IV. Provider business mailing address

PO BOX 1027
NEWMAN LAKE WA
99025-1027
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-8710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: