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General NPI Number Information
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NPI Number | 1336411412
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Entity Type | Individual
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Provider Name | MELISSA JOHNSON RHYASEN P.A.
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Gender | Female
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 123 C AVE
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-2353
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Country | US
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Telephone | 503-905-9006
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2430
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City | THE DALLES
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State | OR
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Zip | 97058-8022
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Country | US
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Telephone | 503-905-9006
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA179385
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License Number State | OR
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