Provider Demographics
NPI:1992961429
Name:PARKER, MELINDA SUE (PA-C)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:SUE
Other - Last Name:PICKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2720 FAIRVIEW AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1306
Mailing Address - Country:US
Mailing Address - Phone:516-336-8836
Mailing Address - Fax:651-331-3459
Practice Address - Street 1:1575 20TH ST NW STE 201
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-2933
Practice Address - Country:US
Practice Address - Phone:651-633-6883
Practice Address - Fax:651-331-3459
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60193376363AM0700X
CO2630363AM0700X
MN11555363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA60193376OtherLICENSE