Healthcare Provider Details

I. General information

NPI: 1285636712
Provider Name (Legal Business Name): JOANNE RUTH MARSH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E NICOLLET BLVD
BURNSVILLE MN
55337-4522
US

IV. Provider business mailing address

400 STINSON BLVD
MINNEAPOLIS MN
55413-2614
US

V. Phone/Fax

Practice location:
  • Phone: 952-460-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6396
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR54246
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: