Provider Demographics
NPI:1427252550
Name:MILKOVICH, MELISSA MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARIE
Last Name:MILKOVICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 9TH ST N
Mailing Address - Street 2:ESSENTIA HEALTH VIRGINIA CLINIC
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2329
Mailing Address - Country:US
Mailing Address - Phone:218-741-0150
Mailing Address - Fax:
Practice Address - Street 1:1101 9TH ST N
Practice Address - Street 2:ESSENTIA HEALTH VIRGINIA CLINIC
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2329
Practice Address - Country:US
Practice Address - Phone:218-741-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 160515-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP716137513514OtherDRIVERS LICENSE
MN500007350Medicare PIN