Provider Demographics
NPI:1336411412
Name:RHYASEN, MELISSA JOHNSON (PA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JOHNSON
Last Name:RHYASEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2430
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-8022
Mailing Address - Country:US
Mailing Address - Phone:503-905-9006
Mailing Address - Fax:
Practice Address - Street 1:123 C AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2353
Practice Address - Country:US
Practice Address - Phone:503-905-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA179385363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical