Provider Demographics
NPI:1588984587
Name:JORDAN, MELISSA A (CRNA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:MORNINGSTAR O'CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:P.O. BOX 946
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022
Mailing Address - Country:US
Mailing Address - Phone:253-797-4908
Mailing Address - Fax:253-939-4245
Practice Address - Street 1:4011 TALBOT RD.
Practice Address - Street 2:5TH FLOOR
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-251-5100
Practice Address - Fax:425-271-2561
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60673443367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered