Individual
STACEY THOMPSON MIETUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
428 MINNESOTA ST STE 500, SAINT PAUL, MN 55101-2666
(612) 662-9604
(612) 474-9072
Mailing address
5100 42ND AVE S, MINNEAPOLIS, MN 55417-1615
(612) 226-2912
(612) 474-9072
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2470293
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6409
MN
Other
Enumeration date
07/22/2014
Last updated
05/14/2024
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