Healthcare Provider Details

I. General information

NPI: 1720876287
Provider Name (Legal Business Name): ALEXUS WILLEY PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49725 COUNTY 83
STAPLES MN
56479-5280
US

IV. Provider business mailing address

2023 SANDSTONE LOOP N
SARTELL MN
56377-4732
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-1515
  • Fax: 218-894-8403
Mailing address:
  • Phone: 218-838-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12786
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: