Individual provider · Type 1 NPI
Melissa Sue Wagner, ACNP
Nurse Practitioner · Bloomington, MN
Practice location
8100 Northland Dr
Bloomington, MN 55431-4800
Mailing address
8170 33rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516
Other practice locations
- 400 S Kingshighway Blvd, St. Louis, MO 63110-1014 · (314) 362-9123
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 2010012196 (MO) |
| Nurse Practitioner Primary | 363L00000X | 3805 (MN) |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1366763708
Melissa Sue Wagner, ACNP's National Provider Identifier is 1366763708, issued on Jun 21, 2010. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Bloomington, MN. The record was last updated on Sep 29, 2026.