Provider Demographics
NPI:1164426714
Name:AUDETTE, MARJORIE LOUISE (CPNP , RN)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:LOUISE
Last Name:AUDETTE
Suffix:
Gender:F
Credentials:CPNP , RN
Other - Prefix:MS
Other - First Name:MARJORIE
Other - Middle Name:LOUISE
Other - Last Name:SEIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3250 WEST 66TH STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-927-7337
Mailing Address - Fax:952-927-8610
Practice Address - Street 1:3250 WEST 66TH STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-927-7337
Practice Address - Fax:952-927-8610
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN88001363LP0200X
MNR0510891364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Not Answered364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics