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General NPI Number Information
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NPI Number | 1467643072
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Entity Type | Individual
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Provider Name | CARRIE J MARZOLF PA
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Gender | Female
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 640 JACKSON ST
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City | SAINT PAUL
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State | MN
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Zip | 55101-2502
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Country | US
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Telephone | 651-254-0063
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Fax | 651-254-5535
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone | 651-254-0063
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Fax | 651-254-5535
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0902
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA001104
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13507
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License Number State | MN
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