Provider Demographics
NPI:1104649474
Name:PORRAS, MELISSA (CNM, NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PORRAS
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Gender:
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 NW HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2453
Mailing Address - Country:US
Mailing Address - Phone:415-730-8686
Mailing Address - Fax:
Practice Address - Street 1:39 NW LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3310
Practice Address - Country:US
Practice Address - Phone:415-730-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201709704RN363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology