MEDICARE: MELISSA BLAGDEN RN, RNFA

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	163WR0006X	Registered Nurse First Assistant	201143298RN	OR

General Provider Information

NPI Number	:	1134603038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BLAGDEN RN, RNFA

Provider Business Mailing Address
First Line	:	12180 SW MERESTONE CT
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-3168
Country	:	US
Telephone Number	:	971-645-8288
Fax Number	:

Provider Business Practice Location Address
First Line	:	12180 SW MERESTONE COURT
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-9722
Country	:	US
Telephone Number	:	971-645-8288
Fax Number	:

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

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2018

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