Melissa Hansen, C.P.N.P.
Individual provider Active NPI Pediatric Nurse Practitioner · Apple Valley, MN
NPI 1760474258 · NPPES record last updated Oct 25, 2012
Key facts
- NPI
- 1760474258
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- R115625-4 (MN)
- Practice address
- 14135 Cedar Ave
Suite 100
Apple Valley, MN 55124-4522 - Phone
- (952) 432-4373
- Fax
- (952) 997-5679
- NPI assigned
- Aug 19, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Pediatric Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R115625-4 | MN | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eagan Valley Pediatrics, P.a. | Past | Accepting new patients | |
| Today Care | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R115625-4 | MN | Yes |
Addresses
Primary practice location
14135 Cedar Ave
Suite 100
Apple Valley, MN 55124-4522
Mailing address
14135 Cedar Ave
Suite 100
Apple Valley, MN 55124-4522
Phone (952) 432-4373
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 605323800 | Medicaid | MN |
Other providers in Apple Valley, MN
- Lucas Hamm
- Andrea Hannem
- Sierra Hanowski
- Bryce Hansen
- Eric E Hansen
- Rachel Hansohn
- Gregory A Hanson
- Michael Hanson
- Sarah Gurine Hanson
- Deborah J Haqq
All providers in Apple Valley, MN · Pediatric Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.