Active NPI
Mary Beth Neisen, FNP-BC
- Family Nurse Practitioner
- Monticello, MN
National Provider Identifier
1861703548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R89486-3
- Practice address
- 9766 Fallon Ave NE Ste 102
Monticello, MN 55362-4589 - Phone
- (763) 272-1500
- Fax
- (763) 272-1503
- NPI assigned
- Jun 28, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R89486-3 | MN | Primary |
Addresses
Primary practice location
9766 Fallon Ave NE Ste 102
Monticello, MN 55362-4589
Mailing address
9766 Fallon Avenue Suite 102
Monticello, MN 55362-4589
Phone (763) 272-1500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R89486-3 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459987200000",
"number": "1861703548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9766 FALLON AVENUE SUITE 102",
"city": "MONTICELLO",
"state": "MN",
"postal_code": "553624589",
"telephone_number": "763-272-1500",
"fax_number": "763-272-1503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9766 FALLON AVE NE STE 102",
"city": "MONTICELLO",
"state": "MN",
"postal_code": "553624589",
"telephone_number": "763-272-1500",
"fax_number": "763-272-1503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEISEN",
"first_name": "MARY",
"middle_name": "BETH",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-28",
"last_updated": "2016-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "R89486-3",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monticello, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.