Individual
STACEY WAYNE MELNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1675 SW MARLOW AVE STE 202, PORTLAND, OR 97225
(503) 430-1777
Mailing address
1675 SW MARLOW AVE STE 202, PORTLAND, OR 97225-5102
(503) 430-1777
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
201350068NP
OR
Other
Enumeration date
04/15/2013
Last updated
08/24/2018
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