Provider Demographics
NPI:1376716407
Name:KOCH, MELINA DOCTO CANLAS (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELINA
Middle Name:DOCTO CANLAS
Last Name:KOCH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:651-254-7676
Practice Address - Street 1:401 PHALEN BLVD - MS 41102D
Practice Address - Street 2:HEALTHPARTNERS SPECIALTY CENTER 401
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2007007786-21363LA2200X
MN2007007785363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2007007785OtherGERONTOLOGICAL NURSE PRAC
2007007786-21OtherADULT NURSE PRACTITIONER