MEDICARE: TIFFANY ANN MELBERG PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R30057	ND

General Provider Information

NPI Number	:	1063782126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY ANN MELBERG PMHNP-BC

Provider Business Mailing Address
First Line	:	1830 E CENTURY AVE UNIT 1
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-0639
Country	:	US
Telephone Number	:	701-339-0300
Fax Number	:	701-401-0299

Provider Business Practice Location Address
First Line	:	1830 E CENTURY AVE UNIT 1
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-0639
Country	:	US
Telephone Number	:	701-751-0699
Fax Number	:	701-401-0299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/07/2025

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