Provider Demographics
NPI:1518509652
Name:GRANT, MELISSA ALINE (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ALINE
Last Name:GRANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ALINE
Other - Last Name:CHARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1000 WESTGATE DR STE 149
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-5000
Mailing Address - Country:US
Mailing Address - Phone:651-641-2900
Mailing Address - Fax:651-641-2901
Practice Address - Street 1:1000 WESTGATE DR STE 149
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-5000
Practice Address - Country:US
Practice Address - Phone:651-641-2900
Practice Address - Fax:651-641-2901
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant