Provider Demographics
NPI:1851857106
Name:MIETUS NP MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:MIETUS NP MENTAL HEALTH, LLC
Other - Org Name:MENTAL WELLBEING NP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SELF-EMPLOYED NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:THOMPSON
Authorized Official - Last Name:MIETUS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:612-226-2912
Mailing Address - Street 1:5100 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:428 MINNESOTA ST STE 500
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2666
Practice Address - Country:US
Practice Address - Phone:612-662-9604
Practice Address - Fax:612-474-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty