Provider Demographics
NPI:1285266205
Name:WHEELER, MELISSA IRENE (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:IRENE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 SW BARBUR BLVD # 119-307
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5428
Mailing Address - Country:US
Mailing Address - Phone:503-245-5933
Mailing Address - Fax:
Practice Address - Street 1:UHS-8L
Practice Address - Street 2:3181 S.W. SAM JACKSON PARK ROAD
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-4989
Practice Address - Fax:503-418-0084
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200540181RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse