Provider Demographics
NPI:1497790372
Name:ZORTMAN, MELODY R (PA-C)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:R
Last Name:ZORTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:R
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 MARKET PTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5435
Mailing Address - Country:US
Mailing Address - Phone:952-767-4574
Mailing Address - Fax:
Practice Address - Street 1:4300 MARKET PTE DR STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5435
Practice Address - Country:US
Practice Address - Phone:952-767-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN395 - TEMP REG.363AS0400X
MN10145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP64494OtherHEALTHPARTNERS
MN2442942OtherAMERICA'S PPO