Healthcare Provider Details

I. General information

NPI: 1437367885
Provider Name (Legal Business Name): STACEY ANN DEHN GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY ANN HERMANSON GNP

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 UNIVERSITY AVE W
SAINT PAUL MN
55104-3727
US

IV. Provider business mailing address

2351 CHILCOMBE AVE
SAINT PAUL MN
55108-1627
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-2002
  • Fax: 651-326-9635
Mailing address:
  • Phone: 651-398-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR1540242
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: