Healthcare Provider Details

I. General information

NPI: 1093276172
Provider Name (Legal Business Name): STEPHANIE DEMARAIS SPERL MSN, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE DEMARAIS VOIGT

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 CAMPUS DR STE 235
PLYMOUTH MN
55441-2678
US

IV. Provider business mailing address

401 SE MAIN ST APT 7031
MINNEAPOLIS MN
55414-4620
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-8300
  • Fax: 952-401-8243
Mailing address:
  • Phone: 320-247-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number2181370
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6450
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: