1568539989 NPI number — MELISSA L HANSES ARNP

Table of content: MELISSA L HANSES ARNP (NPI 1568539989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568539989 NPI number — MELISSA L HANSES ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSES
Provider First Name:
MELISSA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568539989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 S 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98902-3550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-494-6700
Provider Business Mailing Address Fax Number:
509-573-6275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 S 11TH AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-575-0114
Provider Business Practice Location Address Fax Number:
509-575-0808
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  AP30005783 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X , with the licence number: RN00139188 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9632795 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0239425 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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