Provider Demographics
NPI:1528168499
Name:THORSON, MELISSA A L (CCNS CCRN CNRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A L
Last Name:THORSON
Suffix:
Gender:F
Credentials:CCNS CCRN CNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 OAKDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2926
Mailing Address - Country:US
Mailing Address - Phone:763-581-3700
Mailing Address - Fax:763-581-3701
Practice Address - Street 1:3300 OAKDALE AVE NORTH
Practice Address - Street 2:NORTH MEMORIAL HEALTH CARE
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-520-7647
Practice Address - Fax:763-520-1022
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN141658-3364SC0200X
MN3722086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP49497OtherHEALTH PARTNERS
0406882OtherMEDICA
965321041OtherPREFERRED ONE
41258500OtherWIMA
MN582463000Medicaid
945SBLEOtherBLUE CROSS BLUE SHIELD