Provider Demographics
NPI:1205020005
Name:BAUMGART, MELISSA M J (APRN-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M J
Last Name:BAUMGART
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2196 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2708
Mailing Address - Country:US
Mailing Address - Phone:516-704-0322
Mailing Address - Fax:
Practice Address - Street 1:700 RAYMOND AVE STE 130
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1778
Practice Address - Country:US
Practice Address - Phone:612-895-1510
Practice Address - Fax:833-979-0945
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR122944-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily