Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D11054 | OR |
Y | 213EG0000X | General Practice | D11054 | OR |
NPI | 1003308339 |
---|---|
Provider Name | Dr. Mariya Stepanovna Melnik |
First Address | Coos Bay, OR 97420-3405 |
Second Address | Coos Bay, OR 97420-2538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 13/06/2019 |