Provider Demographics
NPI:1063287126
Name:CUMMINGS, MELISSA BETH (APN-FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BETH
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:APN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 LAKE ST S STE D
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2666
Mailing Address - Country:US
Mailing Address - Phone:651-247-0677
Mailing Address - Fax:
Practice Address - Street 1:608 LAKE ST S STE D
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2666
Practice Address - Country:US
Practice Address - Phone:651-464-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine