Individual
MELISSA MARIE EKHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-1000
Mailing address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-1000
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
R157852-8
MN
363LP0200X
Pediatric Nurse Practitioner
Primary
R1578528
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
09/21/2006
Last updated
09/28/2016
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