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General NPI Number Information
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NPI Number | 1528540671
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Entity Type | Individual
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Provider Name | EMRE JOSIAH MICHELLE MAULEON CPNP, APRM
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Gender | Male
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 2512 S 7TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1404
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Country | US
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Telephone | 612-365-6777
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Fax | 612-365-8001
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Provider Business Mailing Address
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Address Line | 927 ALGONQUIN AVE
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City | SAINT PAUL
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State | MN
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Zip | 55119-3703
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Country | US
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Telephone | 651-587-8135
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0003X
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Taxonomy Name | Inpatient Obstetric Registered Nurse
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License Number | R1907490
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 6201
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License Number State | MN
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