Healthcare Provider Details

I. General information

NPI: 1871607515
Provider Name (Legal Business Name): INGRID E BJERKNES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 COMO AVE
SAINT PAUL MN
55108-1720
US

IV. Provider business mailing address

5732 OAKRIDGE CT S
AFTON MN
55001-4404
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-5323
  • Fax: 844-385-4635
Mailing address:
  • Phone: 612-805-6719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number906
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: