Provider Demographics
NPI:1871607515
Name:BJERKNES, INGRID E (PA-C)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:E
Last Name:BJERKNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5732 OAKRIDGE CT S
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:MN
Mailing Address - Zip Code:55001-4404
Mailing Address - Country:US
Mailing Address - Phone:612-805-6719
Mailing Address - Fax:
Practice Address - Street 1:2230 COMO AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1720
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:844-385-4635
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN906OtherMN LICENSE
MN906OtherMN LICENSE