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General NPI Number Information
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NPI Number | 1174143093
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Entity Type | Individual
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Provider Name | MELISSA DYBVIG
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Gender | Female
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 825 N 43RD AVE E
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City | DULUTH
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State | MN
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Zip | 55804-1939
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Country | US
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Telephone | 218-340-9079
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Fax |
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Provider Business Mailing Address
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Address Line | 825 N 43RD AVE E
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City | DULUTH
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State | MN
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Zip | 55804-1939
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Country | US
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Telephone | 218-340-9079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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