Provider Demographics
NPI:1396934121
Name:WIXSTEN, MAUREEN ELAINE (APRN-BC)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ELAINE
Last Name:WIXSTEN
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:ELAINE
Other - Last Name:THUMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-1565
Mailing Address - Fax:612-467-5222
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-1565
Practice Address - Fax:612-467-5222
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 167524-3364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health