Provider Demographics
NPI:1982761763
Name:KJERVIK, MARCEA EDITH (RN,MS,CS)
Entity type:Individual
Prefix:MS
First Name:MARCEA
Middle Name:EDITH
Last Name:KJERVIK
Suffix:
Gender:F
Credentials:RN,MS,CS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5817 CREEK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1211
Mailing Address - Country:US
Mailing Address - Phone:952-941-8484
Mailing Address - Fax:
Practice Address - Street 1:1919 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3453
Practice Address - Country:US
Practice Address - Phone:651-266-7999
Practice Address - Fax:651-266-7850
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0938347363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health