Provider Demographics
NPI:1104224666
Name:ATAY, MEVHIBE MERAL (NP, PHD)
Entity type:Individual
Prefix:
First Name:MEVHIBE
Middle Name:MERAL
Last Name:ATAY
Suffix:
Gender:F
Credentials:NP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S MAPLE ST
Mailing Address - Street 2:ATTN: MEDICAL STAFF OFFICE
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1791
Mailing Address - Country:US
Mailing Address - Phone:952-442-2191
Mailing Address - Fax:952-442-8055
Practice Address - Street 1:111 HUNDERTMARK RD STE 440
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1460
Practice Address - Country:US
Practice Address - Phone:952-856-4033
Practice Address - Fax:952-856-4034
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN162274-6363LA2200X
MN2792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1104224666Medicaid