Provider Demographics
NPI:1720264880
Name:IVERSON, MARLENE ANNA (RN)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:ANNA
Last Name:IVERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:ANNA
Other - Last Name:KRETZSCHMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:501 3RD AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:MN
Mailing Address - Zip Code:56257
Mailing Address - Country:US
Mailing Address - Phone:320-668-2552
Mailing Address - Fax:320-668-2554
Practice Address - Street 1:501 3RD AVE NORTH
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:MN
Practice Address - Zip Code:56257
Practice Address - Country:US
Practice Address - Phone:320-668-2552
Practice Address - Fax:320-668-2554
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1284621163W00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No251E00000XAgenciesHome Health