Physician Compare National (NPI:1538504782)

HEALTHCARE PROVIDER: MELISSA FAE NYSTUEN LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1538504782
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8224332085
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160215002369
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NYSTUEN
	Individual professional last name
Provider First Name	MELISSA
	Individual professional first name
Provider Middle Name	F
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	17 S MAIN ST
	Group Practice or individual's line 1 address
City	CROSBY
	Group Practice or individual's city
State	ND
	Group Practice or individual's state
Zip Code	587300136
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y