Healthcare Provider Details

I. General information

NPI: 1477806800
Provider Name (Legal Business Name): DANIELLE LEE FERKINGSTAD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 TALMAGE CIR STE 216
VADNAIS HEIGHTS MN
55110-7100
US

IV. Provider business mailing address

3640 TALMAGE CIR STE 216
VADNAIS HEIGHTS MN
55110-7100
US

V. Phone/Fax

Practice location:
  • Phone: 952-431-5330
  • Fax: 952-431-5334
Mailing address:
  • Phone: 952-431-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number89233
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: