Provider Demographics
NPI:1275502841
Name:ROMSTAD, ALISON CAROLINE (GNP)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:CAROLINE
Last Name:ROMSTAD
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:CAROLINE
Other - Last Name:LOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:952-914-1847
Mailing Address - Fax:
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2111
Practice Address - Country:US
Practice Address - Phone:952-836-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1450646363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNQ24573Medicare UPIN