Provider Demographics
NPI:1730721895
Name:CHIN, MELISSA MOY (APRN, CNM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MOY
Last Name:CHIN
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 6TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1340
Mailing Address - Country:US
Mailing Address - Phone:612-790-2231
Mailing Address - Fax:
Practice Address - Street 1:606 24TH AVE S STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1437
Practice Address - Country:US
Practice Address - Phone:612-273-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN417176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife