Provider Demographics
NPI:1831815109
Name:BRAUN, MELISSA RAYNE HEIDER (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAYNE HEIDER
Last Name:BRAUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:HEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9135 SW BARNES RD STE 663
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6683
Mailing Address - Country:US
Mailing Address - Phone:503-297-1078
Mailing Address - Fax:503-292-2176
Practice Address - Street 1:2226 NW PETTYGROVE ST STE 161
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2608
Practice Address - Country:US
Practice Address - Phone:503-297-1078
Practice Address - Fax:503-292-2176
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202200910NP-PP208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology