Provider Demographics
NPI:1912382193
Name:RICHERT, MELANIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:RICHERT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 PHALEN BLVD
Mailing Address - Street 2:MS51103B
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-5302
Mailing Address - Country:US
Mailing Address - Phone:651-254-8600
Mailing Address - Fax:651-254-8656
Practice Address - Street 1:435 PHALEN BLVD
Practice Address - Street 2:MS51103B
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-8600
Practice Address - Fax:651-254-8656
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1914580363L00000X
MNCNP 4078363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner