Healthcare Provider Details

I. General information

NPI: 1679438600
Provider Name (Legal Business Name): MELISSA SUE SHENE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6068 E BOWMAN LAKE RD
DULUTH MN
55803-9416
US

IV. Provider business mailing address

6068 E BOWMAN LAKE RD
DULUTH MN
55803-9416
US

V. Phone/Fax

Practice location:
  • Phone: 218-349-7691
  • Fax:
Mailing address:
  • Phone: 218-349-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR190884
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: