Healthcare Provider Details

I. General information

NPI: 1558390336
Provider Name (Legal Business Name): MARIANNE RENAE FOLDESI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 DELMORE DRIVE
ROSEAU MN
56751
US

IV. Provider business mailing address

412 MAIN AVE NE
WARROAD MN
56763-2342
US

V. Phone/Fax

Practice location:
  • Phone: 218-463-1365
  • Fax: 320-259-8044
Mailing address:
  • Phone: 218-386-2020
  • Fax: 218-386-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9621
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9621
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: