Healthcare Provider Details

I. General information

NPI: 1013010172
Provider Name (Legal Business Name): MARJORIE G WEBB CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARJORIE G MOHR CNP

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SMITH AVE N STE 400
SAINT PAUL MN
55102-2534
US

IV. Provider business mailing address

3197 HIGHWAY 29
WILSON WI
54027
US

V. Phone/Fax

Practice location:
  • Phone: 651-292-0616
  • Fax:
Mailing address:
  • Phone: 715-772-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR127314-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: