Basic Information
| Provider Information | |||||||||
| NPI: | 1861567497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARX | ||||||||
| FirstName: | CHRISTA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1450 | ||||||||
| Address2: | NW 6035 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554851450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525428553 | ||||||||
| FaxNumber: | 9525136880 | ||||||||
| Practice Location | |||||||||
| Address1: | 166 19TH ST S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SARTELL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563774654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202294633 | ||||||||
| FaxNumber: | 3202513806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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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 | 363L00000X | R156086-6 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 234594300 | 05 | MN | MEDICAID |