Healthcare Provider Details

I. General information

NPI: 1457747974
Provider Name (Legal Business Name): KAREN JOY MARIENAU M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 JAMES AVE
SAINT PAUL MN
55105-1317
US

IV. Provider business mailing address

316 NORTH ROBERT ST, SUITE 362 WARNER E. BURGER FEDERAL BUILDING AND U.S. COUTRHOUSE
SAINT PAUL MN
55101
US

V. Phone/Fax

Practice location:
  • Phone: 651-699-6374
  • Fax:
Mailing address:
  • Phone: 651-290-3051
  • Fax: 651-290-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number58808
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: