Provider Demographics
NPI:1841314077
Name:TELL, MIRIAM ELAINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ELAINE
Last Name:TELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-9419
Mailing Address - Fax:218-759-4807
Practice Address - Street 1:1526 30TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4140
Practice Address - Country:US
Practice Address - Phone:218-751-0887
Practice Address - Fax:218-759-4807
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR127204-4363LP0808X
OR200650185NP282N00000X
MN3685363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No282N00000XHospitalsGeneral Acute Care Hospital