Healthcare Provider Details

I. General information

NPI: 1528540671
Provider Name (Legal Business Name): EMRE JOSIAH MICHELLE MAULEON CPNP, APRM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

IV. Provider business mailing address

927 ALGONQUIN AVE
SAINT PAUL MN
55119-3703
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax: 612-365-8001
Mailing address:
  • Phone: 651-587-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberR1907490
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6201
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: