Provider Demographics
NPI:1366419723
Name:FELT, MARY J (RN CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:FELT
Suffix:
Gender:F
Credentials:RN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215
Mailing Address - Country:US
Mailing Address - Phone:320-843-2030
Mailing Address - Fax:320-314-1542
Practice Address - Street 1:1805 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215
Practice Address - Country:US
Practice Address - Phone:320-843-2030
Practice Address - Fax:320-314-1542
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR0846743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN327318100Medicaid