Healthcare Provider Details

I. General information

NPI: 1518343904
Provider Name (Legal Business Name): MELANIE ADAMS RN60262073, AP613156
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S 47TH AVE STE C
YAKIMA WA
98908-3204
US

IV. Provider business mailing address

421 S 47TH AVE STE C
YAKIMA WA
98908-3204
US

V. Phone/Fax

Practice location:
  • Phone: 509-969-9393
  • Fax:
Mailing address:
  • Phone: 509-969-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61315692
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60262073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: