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General NPI Number Information
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NPI Number | 1104649474
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Entity Type | Individual
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Provider Name | MELISSA PORRAS CNM, NP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 39 NW LOUISIANA AVE
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City | BEND
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State | OR
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Zip | 97703-3310
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Country | US
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Telephone | 415-730-8686
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Fax |
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Provider Business Mailing Address
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Address Line | 1699 NW HARTFORD AVE
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City | BEND
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State | OR
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Zip | 97703-2453
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Country | US
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Telephone | 415-730-8686
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Fax |
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 201709704RN
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License Number State | OR
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