Basic Information
| Provider Information | |||||||||
| NPI: | 1982761763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KJERVIK | ||||||||
| FirstName: | MARCEA | ||||||||
| MiddleName: | EDITH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | R.N.,M.S.,C.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5817 CREEK VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554391211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529418484 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1919 UNIVERSITY AVE W | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667999 | ||||||||
| FaxNumber: | 6512667850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | R0938347 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.