Provider Demographics
NPI:1245298504
Name:ANDERSSON, INGRID SOFIA (RN, CNM)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:SOFIA
Last Name:ANDERSSON
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 LUCIA CRST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3312
Mailing Address - Country:US
Mailing Address - Phone:608-231-1882
Mailing Address - Fax:608-231-1882
Practice Address - Street 1:3530 LUCIA CRST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3312
Practice Address - Country:US
Practice Address - Phone:608-231-1882
Practice Address - Fax:608-231-1882
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI121560-32367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38267200Medicaid