| Doctor Name: | MRS. MARFA IVANOVNA MAMETIEFF |
| NPI Number: | 1144514159 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 224 3rd St Sw Fosston, MN - 565421609 |
| Business Phone Number: | 2182800894 |
| Business Fax Number: | |
| Mailing Address: | 32758 310th St Se, FOSSTON |
| State: | MN |
| Postal Code: | 565429396 |
| Phone Number: | 2182805084 |
| Fax Number: | |
| NPI Enumeration Date: | 06/07/2011 |
| NPI Last Update Date: | 06/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |