Individual
MELISSA DERHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
715 LINCOLN ST, EUGENE, OR 97401-2502
(541) 344-3574
(541) 344-5652
Mailing address
715 LINCOLN ST, EUGENE, OR 97401-2502
(541) 344-3574
(541) 344-5652
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201330198
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230475
—
OR
Enumeration date
06/29/2016
Last updated
06/29/2016
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