Provider Demographics
NPI:1477806800
Name:FERKINGSTAD, DANIELLE LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEE
Last Name:FERKINGSTAD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 TALMAGE CIR STE 216
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55110-7100
Mailing Address - Country:US
Mailing Address - Phone:952-431-5330
Mailing Address - Fax:
Practice Address - Street 1:3640 TALMAGE CIR STE 216
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55110-7100
Practice Address - Country:US
Practice Address - Phone:952-431-5330
Practice Address - Fax:952-431-5334
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN89233367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered