Healthcare Provider Details

I. General information

NPI: 1922099696
Provider Name (Legal Business Name): MELISSA R OTTENBACHER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA RENEE PHELPS PNP FNP MSN

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S KITSAP BLVD STE 2300
PORT ORCHARD WA
98366-3773
US

IV. Provider business mailing address

9951 MICKELBERRY RD NW STE 101
SILVERDALE WA
98383-8309
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-0216
  • Fax: 360-895-7919
Mailing address:
  • Phone: 360-692-9362
  • Fax: 360-392-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP60103856
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberRN00167987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: