Individual
GREGORY S MELLESMOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9645 GROVE CIR N STE 250, MAPLE GROVE, MN 55369
(763) 201-8191
(763) 201-8192
Mailing address
9645 GROVE CIR N STE 250, MAPLE GROVE, MN 55369-4466
(763) 201-8191
(763) 201-8192
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0779700
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
937843000
—
MN
Enumeration date
03/23/2006
Last updated
06/13/2018
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