Provider Demographics
NPI:1487699252
Name:MELGARD, MARGARET A (RN PAC)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:A
Last Name:MELGARD
Suffix:
Gender:F
Credentials:RN PAC
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 HILLIGOSS BLVD SE
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1542
Mailing Address - Country:US
Mailing Address - Phone:218-435-1133
Mailing Address - Fax:
Practice Address - Street 1:4622 40TH AVE S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4394
Practice Address - Country:US
Practice Address - Phone:701-364-2909
Practice Address - Fax:701-364-9822
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9517363A00000X
NDPAC0374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN142344OtherUCARE #
MN82D57MEOtherMNBS #
MN0110234OtherMEDICA #
MN18983OtherNDBS #
MNHP38587OtherHEALTHPARTNERS #
MNDA9021026981OtherPREFERRED ONE #
MN912638OtherAMERICA'S PPO/ARAZ #
MN377100800Medicaid
MN970015499Medicare ID - Type UnspecifiedRR MEDICARE #
MN912638OtherAMERICA'S PPO/ARAZ #
MN82D57MEOtherMNBS #