Provider Demographics
NPI:1972756997
Name:ASARE, MARDEA MERCEDES (RN)
Entity Type:Individual
Prefix:
First Name:MARDEA
Middle Name:MERCEDES
Last Name:ASARE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARDEA
Other - Middle Name:MERCEDES
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5811 CEDAR LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-544-6223
Mailing Address - Fax:952-544-6271
Practice Address - Street 1:5811 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1458
Practice Address - Country:US
Practice Address - Phone:952-544-6223
Practice Address - Fax:952-544-6271
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR148744-4163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care