Provider Demographics
NPI:1700824695
Name:MARYSTONE, JANE F (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:MARYSTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:342 13TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1265
Mailing Address - Country:US
Mailing Address - Phone:612-362-4111
Mailing Address - Fax:612-362-4115
Practice Address - Street 1:342 13TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1265
Practice Address - Country:US
Practice Address - Phone:612-362-4111
Practice Address - Fax:612-362-4115
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN376602083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF87269Medicare UPIN