Provider Demographics
NPI:1043932544
Name:DAHLSTROM, INGRID
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:DAHLSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PACE UNIVERSITY
Mailing Address - Street 2:1 PACE PLAZA
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PACE UNIVERSITY
Practice Address - Street 2:1 PACE PLAZA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038
Practice Address - Country:US
Practice Address - Phone:800-874-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program