=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972918472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELINDA KAY ANDERSON DNP, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2014
-----------------------------------------------------
Last Update Date | 11/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 CONEY ST W
-----------------------------------------------------
City | PERHAM
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56573-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-347-4500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 8TH AVE NW
-----------------------------------------------------
City | PERHAM
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56573-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-367-8811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R-217848-0
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------