Provider Demographics
NPI:1285619015
Name:ASPEN, FERN MARIE (CNM)
Entity type:Individual
Prefix:MS
First Name:FERN
Middle Name:MARIE
Last Name:ASPEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1500 CURVE CREST BLVD W
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6040
Mailing Address - Country:US
Mailing Address - Phone:651-439-1234
Mailing Address - Fax:651-439-1547
Practice Address - Street 1:921 GREELEY ST S
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5935
Practice Address - Country:US
Practice Address - Phone:651-439-1234
Practice Address - Fax:651-439-1547
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1400285367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38228100Medicaid
MN839663900Medicaid
WI38228100Medicaid
MNP41085Medicare UPIN