Healthcare Provider Details

I. General information

NPI: 1447335963
Provider Name (Legal Business Name): MELISSA C. SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 160
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

75-184 HUALALAI RD
KAILUA KONA HI
96740-1719
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1060
  • Fax: 360-514-1065
Mailing address:
  • Phone: 808-334-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-6596
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD00036379
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: