Provider Demographics
NPI:1922816883
Name:MIRABILIS HEALTH
Entity type:Organization
Organization Name:MIRABILIS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:320-223-0260
Mailing Address - Street 1:8990 70TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-2069
Mailing Address - Country:US
Mailing Address - Phone:320-223-0260
Mailing Address - Fax:
Practice Address - Street 1:7981 TOWN HALL RD NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-2117
Practice Address - Country:US
Practice Address - Phone:320-223-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty