Provider Demographics
NPI:1871202275
Name:WHEELER, MELISSA ANN (LAC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 NW OVERTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1618
Mailing Address - Country:US
Mailing Address - Phone:540-354-5374
Mailing Address - Fax:
Practice Address - Street 1:1971 NW OVERTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1618
Practice Address - Country:US
Practice Address - Phone:971-302-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC213797171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist