Provider Demographics
NPI:1154438117
Name:STEPHENS, INGRID G (CRNA)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:G
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:G
Other - Last Name:RODNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:ESSENTIA HEALTH DULUTH CLINIC
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:218-786-8364
Practice Address - Street 1:400 E 3RD ST
Practice Address - Street 2:ESSENTIA HEALTH DULUTH CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-786-8364
Practice Address - Fax:218-786-8364
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148819-030163W00000X
CO124140163W00000X
MNR 066877-2163W00000X
MN022816367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered