Healthcare Provider Details

I. General information

NPI: 1760805261
Provider Name (Legal Business Name): MELISSA SCHMIDT HEINONEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA RUTH SCHMIDT

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 CARMEN AVE E DAKOTA PEDIATRICS
INVER GROVE HEIGHTS MN
55076
US

IV. Provider business mailing address

142 18TH AVE N.
HOPKINS MN
55343
US

V. Phone/Fax

Practice location:
  • Phone: 651-455-9697
  • Fax: 651-455-2012
Mailing address:
  • Phone: 801-633-3968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR216400-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: