Provider Demographics
NPI:1588493456
Name:WEIDNER, MELISSA JEAN (DNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11108 CHENNAULT BEACH RD APT 918
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-4909
Mailing Address - Country:US
Mailing Address - Phone:443-538-3906
Mailing Address - Fax:
Practice Address - Street 1:11108 CHENNAULT BEACH RD APT 918
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4909
Practice Address - Country:US
Practice Address - Phone:443-538-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61207361163WP0808X
WAAP61592032363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health