Provider Demographics
NPI:1538187901
Name:CHURCH, MELINDA L (ARNP)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:L
Last Name:CHURCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MELINDA
Other - Middle Name:L
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, NP-C, ARNP
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-258-3900
Mailing Address - Fax:
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-339-5422
Practice Address - Fax:425-303-3053
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14914363LF0000X
WAAP61572848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily