Healthcare Provider Details

I. General information

NPI: 1821854472
Provider Name (Legal Business Name): MELISSA MARY SEDEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11475 ROBINSON DR NW
COON RAPIDS MN
55433-3746
US

IV. Provider business mailing address

11475 ROBINSON DR NW
COON RAPIDS MN
55433-3746
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-9000
  • Fax:
Mailing address:
  • Phone: 763-587-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number2173757
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11919
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: