Provider Demographics
NPI:1144092743
Name:HALDEMAN, MELISSA SUE (APRN, PMHNP-BC, DNP)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SUE
Last Name:HALDEMAN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 MANOR BROOK DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3180
Mailing Address - Country:US
Mailing Address - Phone:507-923-8231
Mailing Address - Fax:
Practice Address - Street 1:101 21ST ST SE STE 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-4322
Practice Address - Country:US
Practice Address - Phone:507-437-6389
Practice Address - Fax:507-396-4477
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10927363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty