Provider Demographics
NPI:1235545310
Name:IRELAND, KATIE ROSS (BSN, CNM)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ROSS
Last Name:IRELAND
Suffix:
Gender:F
Credentials:BSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5110
Mailing Address - Country:US
Mailing Address - Phone:651-600-3035
Mailing Address - Fax:651-348-8783
Practice Address - Street 1:3620 14TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2712
Practice Address - Country:US
Practice Address - Phone:952-451-3085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 144301-9367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife