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General NPI Number Information
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NPI Number | 1346033271
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Entity Type | Individual
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Provider Name | MELISSA LYNN VOLENTINE
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Gender | Female
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 1717 SW MADISON ST # 14
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City | PORTLAND
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State | OR
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Zip | 97205-1716
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Country | US
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Telephone | 971-610-3118
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Fax |
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Provider Business Mailing Address
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Address Line | 12645 SE DIVISION ST APT 14
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City | PORTLAND
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State | OR
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Zip | 97236-3197
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Country | US
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Telephone | 971-610-3118
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 113414
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License Number State | OR
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