Provider Demographics
NPI:1376851741
Name:MEZERA, JOAN (RN MA APNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MEZERA
Suffix:
Gender:F
Credentials:RN MA APNP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1690 UNIVERSITY AVE W STE 370
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3723
Mailing Address - Country:US
Mailing Address - Phone:651-232-5321
Mailing Address - Fax:651-326-8170
Practice Address - Street 1:2945 HAZELWOOD ST STE 100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1242
Practice Address - Country:US
Practice Address - Phone:651-232-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI89566-30363LP0200X
MN5806363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376851741Medicaid