Provider Demographics
NPI:1063577971
Name:IRVING, KARIS ANTONIA STENBACK (MD)
Entity type:Individual
Prefix:
First Name:KARIS
Middle Name:ANTONIA STENBACK
Last Name:IRVING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARIS
Other - Middle Name:ANTONIA
Other - Last Name:STENBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2101 ELM ST NE
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2417
Mailing Address - Country:US
Mailing Address - Phone:615-918-0639
Mailing Address - Fax:612-749-3990
Practice Address - Street 1:2101 ELM ST NE
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:615-918-0639
Practice Address - Fax:612-749-3990
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065081A2084P0800X
390200000X
CA1365142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program