Provider Demographics
NPI:1992349088
Name:MELVILLE, JULIE ANNA (LPN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNA
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ANNA
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1542 NE LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3368
Mailing Address - Country:US
Mailing Address - Phone:541-913-8530
Mailing Address - Fax:
Practice Address - Street 1:4115 SE HAGER LN
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2925
Practice Address - Country:US
Practice Address - Phone:541-913-8530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201402605LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse