Healthcare Provider Details

I. General information

NPI: 1003462284
Provider Name (Legal Business Name): MELLEN TOWNSEND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

V. Phone/Fax

Practice location:
  • Phone: 800-456-5653
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN210421
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN210421
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: