Provider Demographics
NPI:1649856527
Name:FALL, MELISSA ANN HELEN (DNP, APRN CPNP AC/PC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN HELEN
Last Name:FALL
Suffix:
Gender:F
Credentials:DNP, APRN CPNP AC/PC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN HELEN
Other - Last Name:FALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:4901 A ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7572
Practice Address - Country:US
Practice Address - Phone:907-854-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK165825363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics