Provider Demographics
NPI:1639517121
Name:PETRANGELO, MELISSA JOY (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOY
Last Name:PETRANGELO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JOY
Other - Last Name:JANSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1444 HAZEL ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4221
Mailing Address - Country:US
Mailing Address - Phone:612-229-4300
Mailing Address - Fax:
Practice Address - Street 1:1444 HAZEL ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4221
Practice Address - Country:US
Practice Address - Phone:612-229-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR192158-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse