Provider Demographics
NPI:1275573891
Name:CROW, MARNA M (CNM)
Entity Type:Individual
Prefix:
First Name:MARNA
Middle Name:M
Last Name:CROW
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3409
Mailing Address - Country:US
Mailing Address - Phone:218-847-5611
Mailing Address - Fax:218-847-0881
Practice Address - Street 1:1027 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3409
Practice Address - Country:US
Practice Address - Phone:218-847-5611
Practice Address - Fax:218-847-0881
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR069384-4367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16062OtherNDBS #
FM0701541OtherMEDICA #
MN142329OtherUCARE #
MN41Q41CROtherMNBS #
MN900601OtherAMERICA'S PPO/ARAZ #
MNHP25731OtherHEALTHPARTNERS #
FMMN200030OtherLHS/BANNERHEALTH #
MNDA9031026965OtherPREFERRED ONE #
MN077819200Medicaid
FM19736Medicaid
MN0701540OtherMEDICA #
FM19736Medicaid
MN0701540OtherMEDICA #
MN142329OtherUCARE #