Provider Demographics
NPI:1982639522
Name:MELROE, NANCY H (ANP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:H
Last Name:MELROE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-6005
Mailing Address - Fax:612-630-8242
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2300
Practice Address - Fax:612-904-4261
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0285850363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04-05395OtherMEDICA
MN541519500Medicaid
MN525S8MEOtherBLUE CROSS BLUE SHIELD
MNS82000Medicare UPIN
MN500002324Medicare Oscar/Certification
MN500003886Medicare Oscar/Certification