MEDICARE: MS. MELINDA MARIE HANSEN RN, CNS

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	171100000X	Acupuncturist	2020	MN
2	364SA2200X	Adult Health Clinical Nurse Specialist	R-123650-1	MN

General Provider Information

NPI Number	:	1508098864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELINDA MARIE HANSEN RN, CNS

Provider Business Mailing Address
First Line	:	7320 GALLAGHER DR
Second Line	:	APARTMENT B324
City	:	EDINA
State	:	MN
Zip	:	55435-4527
Country	:	US
Telephone Number	:	612-875-0566
Fax Number	:

Provider Business Practice Location Address
First Line	:	7320 GALLAGHER DR APT 324
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-3156
Country	:	US
Telephone Number	:	612-875-0566
Fax Number	:

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

Provider Enumeration Date	:	08/19/2009
Last Update Date	:	10/12/2022

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