Provider Demographics
NPI:1164979621
Name:FELDMAN, MARQUITA (CRNP)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 CAMPUS DR STE W225
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2752
Mailing Address - Country:US
Mailing Address - Phone:415-504-3838
Mailing Address - Fax:415-504-1367
Practice Address - Street 1:3033 CAMPUS DR STE W225
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2752
Practice Address - Country:US
Practice Address - Phone:415-504-3838
Practice Address - Fax:415-504-1367
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily