Healthcare Provider Details

I. General information

NPI: 1417121203
Provider Name (Legal Business Name): MARIE LOUISE MIESEL RN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 REN MAR DR STE 100
PLEASANT VIEW TN
37146-3722
US

IV. Provider business mailing address

254 REN MAR DR STE 100
PLEASANT VIEW TN
37146-3722
US

V. Phone/Fax

Practice location:
  • Phone: 615-746-0203
  • Fax: 615-746-0001
Mailing address:
  • Phone: 615-746-0203
  • Fax: 615-746-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number13055
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: