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General NPI Number Information
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NPI Number | 1992570212
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Entity Type | Individual
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Provider Name | MELANIE LARK MUGRAGE RN
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Gender | Female
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 4301 S PINE ST
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City | TACOMA
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State | WA
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Zip | 98409-7264
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Country | US
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Telephone | 253-215-2667
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Fax | 253-444-2261
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Provider Business Mailing Address
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Address Line | 9902 216TH AVE E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-3701
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Country | US
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Telephone | 253-455-3560
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Fax | 253-444-2261
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN60232270
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License Number State | WA
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