Provider Demographics
NPI:1215785258
Name:RICKARD, MELINDA (LICENSE PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:RICKARD
Suffix:
Gender:F
Credentials:LICENSE PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-1154
Mailing Address - Country:US
Mailing Address - Phone:760-468-6491
Mailing Address - Fax:760-433-8469
Practice Address - Street 1:750 WALKER RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-1154
Practice Address - Country:US
Practice Address - Phone:760-468-6491
Practice Address - Fax:760-433-8469
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246QB0000X, 246QM0706X, 246QM0900X
CACPA-00003683246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246QB0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyBlood BankingGroup - Multi-Specialty
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA588868439OtherPASSPORT
ORC805650OtherDRIVER'S LICENSE
CA588868430OtherPASSPORT