Healthcare Provider Details

I. General information

NPI: 1982761763
Provider Name (Legal Business Name): MARCEA EDITH KJERVIK R.N.,M.S.,C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 UNIVERSITY AVE W SUITE 200
SAINT PAUL MN
55104-3453
US

IV. Provider business mailing address

5817 CREEK VALLEY RD
EDINA MN
55439-1211
US

V. Phone/Fax

Practice location:
  • Phone: 651-266-7999
  • Fax: 651-266-7850
Mailing address:
  • Phone: 952-941-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR0938347
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: