Provider Demographics
NPI:1952052912
Name:WALKER, MELISSA ROSE (CNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:WALKER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ROSE
Other - Last Name:FULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39439 TWILIGHT RD
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-7928
Mailing Address - Country:US
Mailing Address - Phone:763-567-0081
Mailing Address - Fax:
Practice Address - Street 1:200 ELM ST N
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-7901
Practice Address - Country:US
Practice Address - Phone:320-532-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8566207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine