Individual
MACKENZIE MARIE MELLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
21260 CHIPPENDALE AVE W, FARMINGTON, MN 55024-1427
(651) 463-7181
Mailing address
21260 CHIPPENDALE AVE W, FARMINGTON, MN 55024-1427
(651) 463-7181
(651) 241-0829
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
MN
Other
Enumeration date
08/09/2022
Last updated
04/27/2023
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