Provider Demographics
NPI:1992727481
Name:ERDMANN, MELISSA R (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:ERDMANN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3274 51ST ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7179
Mailing Address - Country:US
Mailing Address - Phone:701-364-3660
Mailing Address - Fax:701-364-3661
Practice Address - Street 1:3274 51ST ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7179
Practice Address - Country:US
Practice Address - Phone:701-364-3660
Practice Address - Fax:701-364-3661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1539486363L00000X
NDR28446363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-27214OtherMEDICA
ND28201OtherBLUE CROSS BLUE SHIELD
ND19785Medicaid
HP49296OtherHEALTHPARTNERS
B20861043118OtherPREFERRED ONE
MN924G5EROtherBLUE CROSS BLUE SHIELD
ND28201OtherBLUE CROSS BLUE SHIELD
ND19785Medicaid