Provider Demographics
NPI:1215073945
Name:LITWILLER, MELISSA RENEE (ARNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:LITWILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 NW B ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1121
Mailing Address - Country:US
Mailing Address - Phone:541-218-0100
Mailing Address - Fax:
Practice Address - Street 1:1690 ROGUE RIVER HWY
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-4770
Practice Address - Country:US
Practice Address - Phone:541-476-2222
Practice Address - Fax:541-476-4844
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750067NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily