Provider Demographics
NPI:1164836268
Name:WASEMILLER, BETH-ANNE JOELLE (APRN)
Entity Type:Individual
Prefix:
First Name:BETH-ANNE
Middle Name:JOELLE
Last Name:WASEMILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BETH-ANNE
Other - Middle Name:JOELLE
Other - Last Name:LASPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12150 87TH PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3017
Mailing Address - Country:US
Mailing Address - Phone:763-516-5270
Mailing Address - Fax:
Practice Address - Street 1:2355 HIGHWAY 36 W STE 400
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3905
Practice Address - Country:US
Practice Address - Phone:763-412-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily