Healthcare Provider Details

I. General information

NPI: 1982320644
Provider Name (Legal Business Name): MELISSA MARIE KRUGER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MARIE KAHL

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 6TH AVE N
SAINT CLOUD MN
56303-2736
US

IV. Provider business mailing address

2820 ISLAND VIEW DR
SAINT CLOUD MN
56301-5923
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-2828
  • Fax:
Mailing address:
  • Phone: 320-980-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9550
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: