MEDICARE: MS. MELISSA LOU COFFEY RN

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	163WL0100X	Lactation Consultant (Registered Nurse)	RN60196061	WA

General Provider Information

NPI Number	:	1548771199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA LOU COFFEY RN

Provider Business Mailing Address
First Line	:	810 NW 92ND ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-3205
Country	:	US
Telephone Number	:	425-351-1475
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 NW 92ND ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-3205
Country	:	US
Telephone Number	:	425-351-1475
Fax Number	:

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

Provider Enumeration Date	:	10/22/2017
Last Update Date	:	07/21/2022

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