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General NPI Number Information
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NPI Number | 1619252392
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Entity Type | Individual
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Provider Name | MELISSA LORRAINE MANNKE NP
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Gender | Female
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD BAIRD HALL ROOM 18
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-8665
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Fax | 503-494-2958
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD BAIRD HALL ROOM 18
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-8665
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Fax | 503-494-2958
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 201403203NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 201403456NP-PP
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License Number State | OR
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