Individual
DEBRA KAY MIKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CNP
Contact information
Practice address
3400 W 66TH STREET, SUITE 290, EDINA, MN 55435
(952) 914-1727
(952) 914-1727
Mailing address
7880 DAWN AVE, INVER GROVE HEIGHTS, MN 55076-3136
(651) 450-5598
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
149363-21
MD
363LG0600X
Gerontology Nurse Practitioner
Primary
146979-23
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0373257-00
—
MN
Enumeration date
01/16/2006
Last updated
08/11/2011
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