Healthcare Provider Details

I. General information

NPI: 1851136188
Provider Name (Legal Business Name): ANDREA JANE METTLER MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 ELM ST
NICOLLET MN
56074-2056
US

IV. Provider business mailing address

712 ELM ST
NICOLLET MN
56074-2056
US

V. Phone/Fax

Practice location:
  • Phone: 507-461-2774
  • Fax:
Mailing address:
  • Phone: 507-461-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14761
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2046318
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: