Basic Information
| Provider Information | |||||||||
| NPI: | 1528540671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAULEON | ||||||||
| FirstName: | EMRE | ||||||||
| MiddleName: | JOSIAH MICHELLE | ||||||||
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| Credential: | CPNP, APRM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 927 ALGONQUIN AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551193703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6515878135 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2512 S 7TH ST | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123656777 | ||||||||
| FaxNumber: | 6123658001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2018 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0003X | R1907490 | MN | N | Nursing Service Providers | Registered Nurse | Obstetric, Inpatient | 363LP0200X | 6201 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.