Mellesmoen, Gregory S

Mellesmoen, Gregory S is an individual health care provider with primary practice located at 9645 Grove Cir N Ste 250 , Maple Grove MN 55369. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Mellesmoen, Gregory S can be contacted via phone (763) 201-8191.

Contact Information

Primary practice address
9645 Grove Cir N Ste 250 Maple Grove MN 55369
Phone: (763) 201-8191
Fax: (763) 201-8192
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X R0779700 Minnesota

Profile Details

NPI number 1689633919
LBN Legal business name Mellesmoen, Gregory S
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2006
Last updated Jun 13th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689633919 NPPES
Minnesota MEDICAID 937843000

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