Healthcare Provider Details

I. General information

NPI: 1699191940
Provider Name (Legal Business Name): MELISSA ROE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST OFC NN519 BOX 356079
SEATTLE WA
98195-6079
US

IV. Provider business mailing address

751 N 92ND ST
SEATTLE WA
98103-3105
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4628
  • Fax:
Mailing address:
  • Phone: 425-495-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00163483
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN00163483
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: