1982930244 NPI number — MELISSA ANN COLE IBCLC, RLC

Table of content: MELISSA ANN COLE IBCLC, RLC (NPI 1982930244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982930244 NPI number — MELISSA ANN COLE IBCLC, RLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
MELISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IBCLC, RLC
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:
1982930244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1906 NW 25TH AVE
Provider Second Line Business Mailing Address:
STE 10
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97210-2567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-830-6455
Provider Business Mailing Address Fax Number:
360-543-7085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 NW 25TH AVE
Provider Second Line Business Practice Location Address:
STE 10
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97210-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-830-6455
Provider Business Practice Location Address Fax Number:
360-543-7085
Provider Enumeration Date:
10/21/2009

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: 174400000X , with the licence number:  10975484 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174N00000X , with the licence number: 10975484 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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