Individual
MS. MELISSA LYNETT FEDERSPIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5736 NE GLISAN ST, PORTLAND, OR 97213-3750
(971) 258-1120
Mailing address
5736 NE GLISAN ST, PORTLAND, OR 97213-3750
(971) 258-1120
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200350112NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
911019392
COMMERCIAL
—
01
—
J555 08
PACIFIC SOURCE
—
Enumeration date
11/17/2005
Last updated
08/09/2022
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