Marion Conwell
Individual provider Active NPI Driver · Rogers, MN
NPI 1922456748 · NPPES record last updated Jun 2, 2016
Key facts
- NPI
- 1922456748
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- X694280447419 (MN)
- Practice address
- 12521 Otto St
Rogers, MN 55374-9199 - Phone
- (763) 229-6014
- NPI assigned
- Jun 2, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| X694280447419 | MN | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | X694280447419 | MN | Yes |
Addresses
Primary practice location
12521 Otto St
Rogers, MN 55374-9199
Mailing address
12521 Otto St
Rogers, MN 55374-9199
Phone (763) 229-6014
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01014569 | Other | MN | MINNESOTA HEALTH CARE PROGRAMS |
Other providers in Rogers, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.