Melissa Derhak, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

201330198 Issued in OR

Practice address

715 Lincoln St
Eugene, OR 97401-2502

Phone

(541) 344-3574

Fax

(541) 344-5652

NPI assigned

Jun 29, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrated Health Clinics of Eugene

  • Methadone Clinic
  • Eugene, OR
  • NPI 1184788796
  NPD (past)
• Integrated Health Management

  • Community/Behavioral Health Agency
  • Eugene, OR
  • NPI 1770944506
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1174974307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 LINCOLN ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012502",
            "telephone_number": "541-344-3574",
            "fax_number": "541-344-5652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 LINCOLN ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012502",
            "telephone_number": "541-344-3574",
            "fax_number": "541-344-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERHAK",
        "first_name": "MELISSA",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-29",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OR",
            "license": "201330198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230475",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denture Masters of Eugene
• Jodi Depaoli, M.A., L.P.C.
• Debra Depew
• Alicia Cristina Derby, L.AC.
• Derek James Bevans DMD
• Brock Anthony Derrick
• Noora Derrington-Via, LMT
• Kristen Ann Desilets
• Richard Earl Desmond Jr., M.S. QMHP
• Susan Holmes Desmond, CCC-SLP

• Licensed Practical Nurse in Eugene, OR
• Providers in Eugene, OR by specialty
• Licensed Practical Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.