Healthcare Provider Details

I. General information

NPI: 1902246168
Provider Name (Legal Business Name): AVERA MARSHALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E GEORGE ST
IVANHOE MN
56142-9707
US

IV. Provider business mailing address

312 E GEORGE ST
IVANHOE MN
56142-9707
US

V. Phone/Fax

Practice location:
  • Phone: 507-694-1414
  • Fax:
Mailing address:
  • Phone: 507-694-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE STREIER
Title or Position: CEO
Credential:
Phone: 507-537-9160