Individual
MELANY KHAMSITTHISACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
400 S 43RD ST, RENTON, WA 98055-5714
(425) 228-3450
Mailing address
6300 30TH AVE SW, SEATTLE, WA 98126-3166
(530) 215-6812
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
61081776
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61081776
RN LICENSE
WA
Enumeration date
03/24/2022
Last updated
03/24/2022
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