Provider Demographics
NPI:1669778973
Name:MAROTZKE, MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MAROTZKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32644 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:VESTA
Mailing Address - State:MN
Mailing Address - Zip Code:56292-1151
Mailing Address - Country:US
Mailing Address - Phone:507-762-3096
Mailing Address - Fax:
Practice Address - Street 1:32644 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:VESTA
Practice Address - State:MN
Practice Address - Zip Code:56292-1151
Practice Address - Country:US
Practice Address - Phone:507-762-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL051211-6164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse