Individual
MRS. MELISSA LEE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1203 IDAHO ST, LEWISTON, ID 83501-1940
(509) 444-8888
Mailing address
611 N IRON BRIDGE WAY, SPOKANE, WA 99202-4932
(509) 444-8888
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
015943
ME
207R00000X
Internal Medicine Physician
Primary
M-10546
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431898000
—
ME
05
—
808286200
—
ID
Enumeration date
07/06/2006
Last updated
07/22/2020
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