Healthcare Provider Details

I. General information

NPI: 1811950280
Provider Name (Legal Business Name): MARTHA JEAN ESBJORNSSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CEDAR ST STE 154
ALEXANDRIA MN
56308-1769
US

IV. Provider business mailing address

111 17TH AVE E
ALEXANDRIA MN
56308-3703
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-2400
  • Fax: 320-762-8047
Mailing address:
  • Phone: 320-762-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR0676751
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: