MEDICARE: MELISSA OZMORE RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	201241613RN	OR
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	201241613RN	OR
3	163W00000X	Registered Nurse	201241613RN	OR

General Provider Information

NPI Number	:	1073404463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA OZMORE RN, BSN

Provider Business Mailing Address
First Line	:	7584 N CURTIS AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-1250
Country	:	US
Telephone Number	:	503-851-6043
Fax Number	:

Provider Business Practice Location Address
First Line	:	7584 N CURTIS AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-1250
Country	:	US
Telephone Number	:	503-851-6043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/24/2025

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