Provider Demographics
NPI:1821302076
Name:LARSON, MELANIE VANESSA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:VANESSA
Last Name:LARSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:YEAVELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 WESTGATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1451
Mailing Address - Country:US
Mailing Address - Phone:612-262-7800
Mailing Address - Fax:
Practice Address - Street 1:1055 WESTGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1451
Practice Address - Country:US
Practice Address - Phone:612-262-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR147972-4363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health