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General NPI Number Information
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NPI Number | 1053753889
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Entity Type | Individual
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Provider Name | MELINDA GROOMS-UNRUH RN
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Gender | Female
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 513 E YACOLT RD
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City | YACOLT
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State | WA
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Zip | 98675-5535
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Country | US
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Telephone | 360-607-6443
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Fax | 360-686-8205
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Provider Business Mailing Address
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Address Line | 513 E YACOLT RD PO BOX 291
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City | YACOLT
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State | WA
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Zip | 98675-5535
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Country | US
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Telephone | 360-607-6443
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Fax | 360-686-8205
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN60218267
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License Number State | WA
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