Healthcare Provider Details

I. General information

NPI: 1962588525
Provider Name (Legal Business Name): MELINDA S. AMENT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LEWIS AVE S
WATERTOWN MN
55388
US

IV. Provider business mailing address

4200 DAHLBERG DR STE 300
GOLDEN VALLEY MN
55422-4841
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-1963
  • Fax: 952-955-1965
Mailing address:
  • Phone: 763-520-7870
  • Fax: 763-520-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 147016 3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: