Provider Demographics
NPI:1699504829
Name:BREDEMUS, MELISSA LYNN (APRN, CNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:BREDEMUS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:BROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5446 RASPBERRY CT NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55374-3500
Mailing Address - Country:US
Mailing Address - Phone:612-237-5814
Mailing Address - Fax:
Practice Address - Street 1:2800 CAMPUS DR STE 20
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2669
Practice Address - Country:US
Practice Address - Phone:763-581-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1745403163W00000X
MN11882363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse