Provider Demographics
NPI:1427601483
Name:MELLAND, ANGELA M (APRN, CNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:MELLAND
Suffix:
Gender:F
Credentials:APRN, CNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 UTICA AVE S STE 450
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3678
Mailing Address - Country:US
Mailing Address - Phone:952-856-8452
Mailing Address - Fax:952-746-4383
Practice Address - Street 1:1550 UTICA AVE S STE 450
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3678
Practice Address - Country:US
Practice Address - Phone:952-856-8452
Practice Address - Fax:952-746-4383
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6719363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health