Healthcare Provider Details

I. General information

NPI: 1902700313
Provider Name (Legal Business Name): MELISSA CORDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 BROADWAY ST
LISBON ND
58054-4618
US

IV. Provider business mailing address

602 BROADWAY ST
LISBON ND
58054-4618
US

V. Phone/Fax

Practice location:
  • Phone: 701-680-3172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: