Healthcare Provider Details

I. General information

NPI: 1851843155
Provider Name (Legal Business Name): MELISSA ANN FUHRMANN APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN BERKLAND

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 5TH AVE SE
SPRING GROVE MN
55974-1318
US

IV. Provider business mailing address

1836 SOUTH AVE
LA CROSSE WI
54601-5429
US

V. Phone/Fax

Practice location:
  • Phone: 507-498-3302
  • Fax:
Mailing address:
  • Phone: 608-782-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP 4852
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: