Healthcare Provider Details

I. General information

NPI: 1619329687
Provider Name (Legal Business Name): NORMAN BILLINGS MEKKELSEN III NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 COLUMBINE RD
EDEN PRAIRIE MN
55344-7610
US

IV. Provider business mailing address

8251 COLUMBINE RD
EDEN PRAIRIE MN
55344-7610
US

V. Phone/Fax

Practice location:
  • Phone: 952-941-1266
  • Fax: 952-941-5296
Mailing address:
  • Phone: 952-941-1266
  • Fax: 952-941-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP4492
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: