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NPI Code Detail

MEDICARE: MELISSA CHRISTINE FAGEN P.A.-C

MEDICARE: MELISSA CHRISTINE FAGEN P.A.-C
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
1363A00000XPhysician Assistant893MN

General Provider Information

NPI Number : 1841210648
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA CHRISTINE FAGEN P.A.-C
Provider Business Mailing Address
First Line : 5058 250TH AVE
Second Line :
City : GRANITE FALLS
State : MN
Zip : 56241-3665
Country : US
Telephone Number : 320-564-4843
Fax Number :
Provider Business Practice Location Address
First Line : 1965 FORD PKWY
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1923
Country : US
Telephone Number : 651-696-5509
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 07/08/2007

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