Provider Demographics
NPI:1528540671
Name:MAULEON, EMRE JOSIAH MICHELLE (CPNP, APRM)
Entity Type:Individual
Prefix:
First Name:EMRE
Middle Name:JOSIAH MICHELLE
Last Name:MAULEON
Suffix:
Gender:M
Credentials:CPNP, APRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 ALGONQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-3703
Mailing Address - Country:US
Mailing Address - Phone:651-587-8135
Mailing Address - Fax:
Practice Address - Street 1:2512 S 7TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1404
Practice Address - Country:US
Practice Address - Phone:612-365-6777
Practice Address - Fax:612-365-8001
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1907490163WX0003X
MN6201363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient