Provider Demographics
NPI:1992537393
Name:SIEMSEN, MIKAYLA ELLEN (CNP)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ELLEN
Last Name:SIEMSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12025 276TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-8923
Mailing Address - Country:US
Mailing Address - Phone:763-350-6676
Mailing Address - Fax:
Practice Address - Street 1:12025 276TH AVE NW
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-8923
Practice Address - Country:US
Practice Address - Phone:763-350-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11970363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care