Individual
MELISSA TROI MATEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA61222414
WA
363AM0700X
Medical Physician Assistant
PA61157642
WA
363AM0700X
Medical Physician Assistant
Primary
PA61222414
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA61222414
DOH LICENSE
WA
Enumeration date
08/17/2020
Last updated
12/06/2022
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