Healthcare Provider Details

I. General information

NPI: 1164678660
Provider Name (Legal Business Name): JENNY K MARSDEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 41ST AVE S
MOORHEAD MN
56560-7418
US

IV. Provider business mailing address

3729 41ST AVE S
MOORHEAD MN
56560-7418
US

V. Phone/Fax

Practice location:
  • Phone: 701-412-1202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10899
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPAC0398
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0398
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: