MEDICARE: MELISSA A VENABLE LMP

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	174400000X	Specialist	MA00021085	WA

General Provider Information

NPI Number	:	1518159193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA A VENABLE LMP

Provider Business Mailing Address
First Line	:	15650 NE 24TH ST
Second Line	:	SUITE E
City	:	BELLEVUE
State	:	WA
Zip	:	98008-2460
Country	:	US
Telephone Number	:	425-827-2225
Fax Number	:	425-283-4192

Provider Business Practice Location Address
First Line	:	15650 NE 24TH ST
Second Line	:	SUITE E
City	:	BELLEVUE
State	:	WA
Zip	:	98008-2460
Country	:	US
Telephone Number	:	425-827-2225
Fax Number	:	425-283-4192

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/16/2007

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