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NPI Code Detail

MEDICARE: MELISSA M. J. BAUMGART APRN-BC

MEDICARE: MELISSA M. J. BAUMGART APRN-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
1363LF0000XFamily Nurse PractitionerR122944-0MN

General Provider Information

NPI Number : 1205020005
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA M. J. BAUMGART APRN-BC
Provider Business Mailing Address
First Line : 2196 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-2708
Country : US
Telephone Number : 516-704-0322
Fax Number :
Provider Business Practice Location Address
First Line : 700 RAYMOND AVE STE 130
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1778
Country : US
Telephone Number : 612-895-1510
Fax Number : 833-979-0945
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2007
Last Update Date : 03/15/2023

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