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General NPI Number Information
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NPI Number | 1720313141
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Entity Type | Individual
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Provider Name | MELISSA ANNETTE SCHRAM LMP
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Gender | Female
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Dates
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Enumeration Date | 10/03/2009
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 109 SE 101ST AVE
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City | VANCOUVER
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State | WA
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Zip | 98664-3907
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Country | US
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Telephone | 360-852-6291
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Fax | 360-852-6291
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Provider Business Mailing Address
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Address Line | 15600 NE 48TH ST
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City | VANCOUVER
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State | WA
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Zip | 98682-5217
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Country | US
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Telephone | 360-852-6291
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA60098708
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License Number State | WA
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