Provider Demographics
NPI:1891838678
Name:SWENSON, MELANIE (APRN, CPNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, CPNP
Mailing Address - Street 1:12048 TERRACE CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3385
Mailing Address - Country:US
Mailing Address - Phone:651-468-7323
Mailing Address - Fax:
Practice Address - Street 1:8500 EDINBROOK PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3720
Practice Address - Country:US
Practice Address - Phone:763-425-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7309363LP0200X
WI148978-030163W00000X
MNR166082-1163W00000X
NDR31568163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse