Provider Demographics
NPI:1689636615
Name:EHLERS-MILLETT, STACEY M (RN, CNP)
Entity Type:Individual
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First Name:STACEY
Middle Name:M
Last Name:EHLERS-MILLETT
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Gender:F
Credentials:RN, CNP
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-8680
Practice Address - Fax:651-254-8656
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN3329363L00000X
MNR123301-2363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP62409Medicare UPIN