Provider Demographics
NPI:1114236858
Name:MIETTUNEN, CAROL S (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:MIETTUNEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2222
Mailing Address - Country:US
Mailing Address - Phone:218-749-1845
Mailing Address - Fax:
Practice Address - Street 1:508 12TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2222
Practice Address - Country:US
Practice Address - Phone:218-749-1845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 174511-5163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health