Provider Demographics
NPI:1467071084
Name:ST. CATHERINE UNIVERSITY SCHOOL BASED HEALTH CLINIC
Entity Type:Organization
Organization Name:ST. CATHERINE UNIVERSITY SCHOOL BASED HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIEHE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:651-653-2923
Mailing Address - Street 1:2004 RANDOLPH AVE.
Mailing Address - Street 2:F-22
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105
Mailing Address - Country:US
Mailing Address - Phone:651-690-6101
Mailing Address - Fax:
Practice Address - Street 1:5045 DIVISION AVE,
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:651-653-2923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CATHERINE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty