Healthcare Provider Details

I. General information

NPI: 1528041043
Provider Name (Legal Business Name): MELISSA HANNER FRISVOLD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 GREELEY ST S
STILLWATER MN
55082-5935
US

IV. Provider business mailing address

1687E DIVISION ST
RIVER FALLS WI
54022-1571
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-1234
  • Fax: 651-439-1547
Mailing address:
  • Phone: 715-425-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR1182312
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: