1457747974 NPI number — DR. KAREN JOY MARIENAU M.D., MPH

Table of content: DR. KAREN JOY MARIENAU M.D., MPH (NPI 1457747974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457747974 NPI number — DR. KAREN JOY MARIENAU M.D., MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARIENAU
Provider First Name:
KAREN
Provider Middle Name:
JOY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457747974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 NORTH ROBERT ST, SUITE 362
Provider Second Line Business Mailing Address:
WARNER E. BURGER FEDERAL BUILDING AND U.S. COUTRHOUSE
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-290-3051
Provider Business Mailing Address Fax Number:
651-290-3560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2095 JAMES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55105-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-699-6374
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X , with the licence number:  58808 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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