Provider Demographics
NPI:1295256964
Name:MURSU, TWILA JOHANNA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TWILA
Middle Name:JOHANNA
Last Name:MURSU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48155 143RD ST
Mailing Address - Street 2:
Mailing Address - City:BIG STONE CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57216-5519
Mailing Address - Country:US
Mailing Address - Phone:605-924-0606
Mailing Address - Fax:320-839-6159
Practice Address - Street 1:450 EASTVOLD AVE
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1133
Practice Address - Country:US
Practice Address - Phone:320-839-6157
Practice Address - Fax:320-839-6159
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001247363LP0808X
MN5231363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1295256964Medicaid