Provider Demographics
NPI:1558379974
Name:VIRNIG, MELISSA A (RN, CNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:VIRNIG
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 FORTHUN ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425
Mailing Address - Country:US
Mailing Address - Phone:218-454-0090
Mailing Address - Fax:218-454-0091
Practice Address - Street 1:7115 FORTHUN ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-454-0090
Practice Address - Fax:218-454-0091
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 141902-7363LP0808X
MNR141902-72084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN237180000Medicaid
MN500003576Medicare UPIN