Provider Demographics
NPI:1235880121
Name:ANDRESEN, MARILYN KAYE (BC-NP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:KAYE
Last Name:ANDRESEN
Suffix:
Gender:F
Credentials:BC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50856 COUNTY 36
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5493
Mailing Address - Country:US
Mailing Address - Phone:218-407-2930
Mailing Address - Fax:
Practice Address - Street 1:50856 COUNTY 36
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5493
Practice Address - Country:US
Practice Address - Phone:218-407-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner