Individual
MELISSA SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
103 WASO, CHILOQUIN, OR 97624
(541) 880-2011
(541) 783-3273
Mailing address
2074 S 6TH ST, KLAMATH FALLS, OR 97601-3372
(541) 880-2011
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
099000635RN
OR
363LF0000X
Family Nurse Practitioner
Primary
200850150NP
OR
Other
Enumeration date
10/16/2008
Last updated
01/15/2015
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