Provider Demographics
NPI:1033360581
Name:MELLUM, EMILY ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:MELLUM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:GERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:701 PARK AVE SOUTH
Mailing Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER/REVENUE MANAGEMENT
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-873-3044
Mailing Address - Fax:612-630-8242
Practice Address - Street 1:701 PARK AVE SOUTH
Practice Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER/REVENUE MANAGEMENT
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-873-3044
Practice Address - Fax:612-630-8242
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1757886367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered