Gregory S Mellesmoen, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R0779700 Issued in MN

Practice address

9645 Grove Cir N Ste 250
Maple Grove, MN 55369

Phone

(763) 201-8191

Fax

(763) 201-8192

NPI assigned

Mar 23, 2006

Sex

Male

Sole proprietor

No

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)

Enrolled

Credentials

Certified Registered Nurse

State licenses

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528848000000",
    "number": "1689633919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 250",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694466",
            "telephone_number": "763-201-8191",
            "fax_number": "763-201-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 250",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-201-8191",
            "fax_number": "763-201-8192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLESMOEN",
        "first_name": "GREGORY",
        "middle_name": "S",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2018-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R0779700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "937843000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charise Michde Mehrkens, PA-C
• Diane M. Meier, M.D.
• Nicole Meier
• Meinzuhause Group Homes
• Chizaria Melikiore
• Melissa M Melrick, OTR/L
• Jewri Merchant
• Nazih Mergoum
• Jerome Patrick Merkel, MD
• Jeffrey Merriam, CRNA

• Certified Registered Nurse Anesthetist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Certified Registered Nurse Anesthetist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2018; 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.