Provider Demographics
NPI:1437367885
Name:DEHN, STACEY ANN (GNP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:DEHN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:HERMANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP
Mailing Address - Street 1:2351 CHILCOMBE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1627
Mailing Address - Country:US
Mailing Address - Phone:651-398-1062
Mailing Address - Fax:
Practice Address - Street 1:1700 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3727
Practice Address - Country:US
Practice Address - Phone:651-232-2002
Practice Address - Fax:651-326-9635
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1540242363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology