Provider Demographics
NPI:1720853799
Name:FJELSTAD, MARRIA ELIZABETH
Entity Type:Individual
Prefix:
First Name:MARRIA
Middle Name:ELIZABETH
Last Name:FJELSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2750
Mailing Address - Country:US
Mailing Address - Phone:952-681-0023
Mailing Address - Fax:
Practice Address - Street 1:1580 WHITE OAK DR STE 275
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2927
Practice Address - Country:US
Practice Address - Phone:952-856-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1100176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife