Provider Demographics
NPI:1518043561
Name:MONIGOLD, MELINDA K (CNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:K
Last Name:MONIGOLD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4516
Mailing Address - Country:US
Mailing Address - Phone:651-431-5226
Mailing Address - Fax:
Practice Address - Street 1:3301 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4516
Practice Address - Country:US
Practice Address - Phone:651-431-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 115468-3363LW0102X, 363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
120374OtherUCARE
MN245444100Medicaid
01-22075OtherMEDICA CHOICE
IA0714246Medicaid
01-18989OtherMEDICA PRIMARY
2386132OtherARAZ
MT4305947Medicaid
1025820OtherPREFERRED ONE
B611OtherTRIWEST/TRICARE
427M8MOOtherBCBS
WI43896700Medicaid
HP30486OtherHEALTHPARTNERS
1025820OtherPREFERRED ONE
S35516Medicare UPIN