Provider Demographics
NPI:1114570298
Name:MIKHAEIL, AMANDA JUNE INAS (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JUNE INAS
Last Name:MIKHAEIL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 4TH ST NE APT 2
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-3352
Mailing Address - Country:US
Mailing Address - Phone:218-296-2639
Mailing Address - Fax:
Practice Address - Street 1:14241 GRAND OAKS DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8749
Practice Address - Country:US
Practice Address - Phone:218-316-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6720363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health