Jenna B Mazour, APRN,CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4772 Issued in MN

Practice address

1027 Washington Ave
Detroit Lakes, MN 56501-3409

Phone

(218) 844-2347

NPI assigned

Jun 22, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, MN, ND3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Marys Regional Health CenterGroup PAC ID 2062326820, 190 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health St Marys - Detroit Lakes Hospital, Detroit Lakes, MN, CCN 240101
• Essentia Health Hospital, Fargo, ND, CCN 350070
• St Josephs Area Health Services Hospital, Park Rapids, MN, CCN 241380

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Marys Regional Health Center

  • Rural Acute Care Hospital
  • Detroit Lakes, MN
  • NPI 1679561088
  Medicare reassignment Care Compare group NPD
• First Care Medical Services

  • Critical Access Hospital Clinic/Center
  • Fosston, MN
  • NPI 1073638565
  Medicare reassignment NPD
• St. Croix Regional Medical Center

  • Critical Access Hospital
  • Saint Croix Falls, WI
  • NPI 1043240922

  MN

  Medicare reassignment NPD
• Catalyst Medical Center PC

  • Otolaryngology Physician
  • Fargo, ND
  • NPI 1043378268
  Medicare reassignment
• First Care Medical Services

  • Rural Health Clinic/Center
  • Oklee, MN
  • NPI 1174812465
  NPD
• St Mary'S Regional Health Center

  • Rural Health Clinic/Center
  • Menahga, MN
  • NPI 1467798322
  NPD
• St Mary'S Regional Health Center

  • Rural Health Clinic/Center
  • Frazee, MN
  • NPI 1902364482
  NPD
• St. Croix Regional Medical Center

  • Rural Health Clinic/Center
  • Balsam Lake, WI
  • NPI 1013423219
  NPD
• St Marys Regional Health Center

  • Multi-Specialty Clinic/Center
  • Park Rapids, MN
  • NPI 1730731464
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Mary'S Regional Health Center

  • Rural Health Clinic/Center
  • Frazee, MN
  • NPI 1902364482

  Hospital

  Care Compare affiliation
• St Marys Regional Health Center

  • Rural Health Clinic/Center
  • Park Rapids, MN
  • NPI 1730706656

  Hospital

  Care Compare affiliation
• St. Joseph'S Area Health Services

  • Critical Access Hospital
  • Park Rapids, MN
  • NPI 1023086055
  Care Compare affiliation
• St. Marys Regional Health Center

  • Rural Acute Care Hospital
  • Detroit Lakes, MN
  • NPI 1679561088
  Care Compare affiliation
• Innovis Health, LLC

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1043661978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "fax_number": "715-483-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 WASHINGTON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013409",
            "telephone_number": "218-844-2347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZOUR",
        "first_name": "JENNA",
        "middle_name": "B",
        "credential": "APRN,CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-22",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "7019",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "4772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Markuson, APRN, CNP
• Guillermo Alfredo Marroquin Galvez, M.D.
• Richard Emil Martin, MD
• Susan M Martodam, LRD
• Leslie R Masciarelli Kisch, OD
• Rachael McArthur
• Diane Jean McCormack, MS, OTR/L
• Tina McDonald
• Michael Joseph McGregor, PA-C
• Gaurav Suresh Mehta, M.D.

• Family Nurse Practitioner in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.