Healthcare Provider Details

I. General information

NPI: 1952884041
Provider Name (Legal Business Name): AUDREY JEAN MARJAMA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY JEAN BRASEL FNP

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 1ST ST E
PARK RAPIDS MN
56470
US

IV. Provider business mailing address

607 TENTH ST W
PARK RAPIDS MN
56470
US

V. Phone/Fax

Practice location:
  • Phone: 218-732-6300
  • Fax: 218-237-7451
Mailing address:
  • Phone: 218-368-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6181
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: