MEDICARE: DR. MELINDA LOUISE BEHRENS MD

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	208000000X	Pediatrics Physician	MD00036803	WA

General Provider Information

NPI Number	:	1427007434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELINDA LOUISE BEHRENS MD

Provider Business Mailing Address
First Line	:	2148 HUNTINGTON LOOP SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98513-3490
Country	:	US
Telephone Number	:	253-968-3066
Fax Number	:	253-968-0384

Provider Business Practice Location Address
First Line	:	2148 HUNTINGTON LOOP SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98513-3490
Country	:	US
Telephone Number	:	360-456-0912
Fax Number	:	253-968-0384

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	02/15/2013

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