Healthcare Provider Details

I. General information

NPI: 1518579622
Provider Name (Legal Business Name): MELISSA KRISTINE ZIELSTORF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N HOLY NAMES CT FL 3
SPOKANE WA
99224-5803
US

IV. Provider business mailing address

525 E CENTRAL AVE
SPOKANE WA
99208-1119
US

V. Phone/Fax

Practice location:
  • Phone: 509-960-8632
  • Fax: 509-960-8655
Mailing address:
  • Phone: 509-290-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: