Provider Demographics
NPI:1467643072
Name:MARZOLF, CARRIE J (PA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:J
Last Name:MARZOLF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:J
Other - Last Name:MARZOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-0063
Mailing Address - Fax:651-254-5535
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-0063
Practice Address - Fax:651-254-5535
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0902363A00000X
MEPA001104363A00000X
MN13507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPA001104OtherMAINE STATE LICENSE
NH0902OtherNEW HAMPSHIRE BOARD OF MEDICINE