Provider Demographics
NPI:1295375871
Name:MARTIN, MELISSA ANN SELDON (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN SELDON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:SELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1114 MONTANA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2245
Mailing Address - Country:US
Mailing Address - Phone:651-319-1344
Mailing Address - Fax:
Practice Address - Street 1:1114 MONTANA AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-2245
Practice Address - Country:US
Practice Address - Phone:651-319-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant