Healthcare Provider Details

I. General information

NPI: 1801660881
Provider Name (Legal Business Name): MELISSA CHRISTINE BRAY-IVERSLIE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA CHRISTINE BRAY-IVERSLIE FNP-BC

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILLMAR AVE SW
WILLMAR MN
56201-3556
US

IV. Provider business mailing address

20190 W ANDREW RD
NEW LONDON MN
56273-8621
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-5000
  • Fax:
Mailing address:
  • Phone: 763-458-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11003
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: