Provider Demographics
NPI:1437484300
Name:MORIZIO, JEANNE L (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:MORIZIO
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:L
Other - Last Name:SCULLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9645 GROVE CIR N STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4466
Mailing Address - Country:US
Mailing Address - Phone:763-201-8191
Mailing Address - Fax:763-201-8192
Practice Address - Street 1:9645 GROVE CIR N STE 200
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-201-8191
Practice Address - Fax:763-201-8192
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR134536-6363L00000X
MNR1345366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner