Provider Demographics
NPI:1578304655
Name:MCAUGHTY, MELISSA G
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:MCAUGHTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-3147
Mailing Address - Country:US
Mailing Address - Phone:801-920-0510
Mailing Address - Fax:
Practice Address - Street 1:992 W IDAHO AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2111
Practice Address - Country:US
Practice Address - Phone:801-920-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program