Provider Demographics
NPI:1104540012
Name:MELZARK, CHRISTY LEAH (NP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEAH
Last Name:MELZARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:LEAH
Other - Last Name:COLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:ASKOV
Mailing Address - State:MN
Mailing Address - Zip Code:55704-0062
Mailing Address - Country:US
Mailing Address - Phone:320-279-7287
Mailing Address - Fax:
Practice Address - Street 1:707 LUNDORFF DR STE 1
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-5099
Practice Address - Country:US
Practice Address - Phone:320-245-2250
Practice Address - Fax:320-245-2555
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily