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NPI Code Detail

MEDICARE: AMY MARGARET MIMM PUBLIC HEALTH NURSE

MEDICARE: AMY MARGARET MIMM PUBLIC HEALTH NURSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC1500XCommunity Health Registered NurseR131559-0MN

General Provider Information

NPI Number : 1164898011
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MARGARET MIMM PUBLIC HEALTH NURSE
Provider Business Mailing Address
First Line : 14955 GALAXIE AVE
Second Line :
City : APPLE VALLEY
State : MN
Zip : 55124-4519
Country : US
Telephone Number : 952-891-7566
Fax Number : 952-891-7565
Provider Business Practice Location Address
First Line : 14955 GALAXIE AVE
Second Line :
City : APPLE VALLEY
State : MN
Zip : 55124-4519
Country : US
Telephone Number : 952-891-7566
Fax Number : 952-891-7565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2015
Last Update Date : 08/14/2015

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Directions to “ AMY MARGARET MIMM PUBLIC HEALTH NURSE” Practice Location

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