Individual
MELANIE GRACE MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
501 N GRAHAM ST STE 420, PORTLAND, OR 97227
(503) 288-7303
(503) 288-7306
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA186897
OR
363AS0400X
Surgical Physician Assistant
Primary
PA186897
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2106620
—
WA
05
—
500751360
—
OR
Enumeration date
08/14/2018
Last updated
09/11/2025
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