Provider Demographics
NPI:1093276172
Name:SPERL, STEPHANIE DEMARAIS (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DEMARAIS
Last Name:SPERL
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DEMARAIS
Other - Last Name:VOIGT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 SE MAIN ST APT 7031
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4620
Mailing Address - Country:US
Mailing Address - Phone:320-247-2120
Mailing Address - Fax:
Practice Address - Street 1:2805 CAMPUS DR STE 235
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2678
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:952-401-8243
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2181370163WP0200X
MN6450363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics