Provider Demographics
NPI:1417121203
Name:MIESEL, MARIE LOUISE (RN, APN)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LOUISE
Last Name:MIESEL
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:254 REN MAR DR
Mailing Address - Street 2:STE 100
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-3722
Mailing Address - Country:US
Mailing Address - Phone:615-746-0203
Mailing Address - Fax:615-746-0001
Practice Address - Street 1:254 REN MAR DR
Practice Address - Street 2:STE 100
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-3722
Practice Address - Country:US
Practice Address - Phone:615-746-0203
Practice Address - Fax:615-746-0001
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN13055363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I501915Medicare PIN