Provider Demographics
NPI:1962737981
Name:HALL, MELISSA FAYE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:FAYE
Last Name:HALL
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6363 FRANCE AVENUE SOUTH
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-920-2070
Mailing Address - Fax:952-920-7444
Practice Address - Street 1:6363 FRANCE AVENUE SOUTH
Practice Address - Street 2:SUITE 400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-920-2070
Practice Address - Fax:952-920-7444
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2012-11-19
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Provider Licenses
StateLicense IDTaxonomies
CT002334363A00000X
MN10837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant