Provider Demographics
NPI:1730432956
Name:MISTEREK, AMY PATTON (NP-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:PATTON
Last Name:MISTEREK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3953 43RD AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3511
Mailing Address - Country:US
Mailing Address - Phone:612-210-4227
Mailing Address - Fax:
Practice Address - Street 1:2828 CHICAGO AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1544
Practice Address - Country:US
Practice Address - Phone:612-863-5390
Practice Address - Fax:612-863-8636
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 157167-7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily