Individual
MRS. MELISSA SUE BRUSACORAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
118 W LAKE ST, CHISHOLM, MN 55719-1819
(218) 254-0101
(844) 921-1071
Mailing address
7478 GREEN ROCK RD, SIDE LAKE, MN 55781-8434
(218) 296-0688
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
2100555
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7331
MN
Other
Enumeration date
09/09/2019
Last updated
07/16/2021
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