Healthcare Provider Details

I. General information

NPI: 1063287126
Provider Name (Legal Business Name): MELISSA BETH CUMMINGS APN-FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA HEINIEMI

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 KELLEY PKWY STE 100
ORONO MN
55356-5801
US

IV. Provider business mailing address

15655 37TH AVE N STE 100
PLYMOUTH MN
55446-4003
US

V. Phone/Fax

Practice location:
  • Phone: 612-293-7822
  • Fax: 612-230-8769
Mailing address:
  • Phone: 612-293-7822
  • Fax: 612-230-8769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11036
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: