Provider Demographics
NPI:1043236516
Name:WILBRAND-CONLEY, INGRID ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:ELIZABETH
Last Name:WILBRAND-CONLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2185
Mailing Address - Country:US
Mailing Address - Phone:651-770-3320
Mailing Address - Fax:651-770-3684
Practice Address - Street 1:1737 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2185
Practice Address - Country:US
Practice Address - Phone:651-770-3320
Practice Address - Fax:651-770-3684
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN25770207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350508100Medicaid
160000515Medicare ID - Type Unspecified
MN350508100Medicaid