Provider Demographics
NPI:1023193778
Name:CHRISTENSEN FROEHLICH, MELISSA (PNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CHRISTENSEN FROEHLICH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1445
Practice Address - Country:US
Practice Address - Phone:763-587-4800
Practice Address - Fax:763-587-4845
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2788363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11651580Medicaid
COQ29495Medicare UPIN
COC800327Medicare PIN