Individual
DEBORAH A IDLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1526 NORTHWAY DR, SAINT CLOUD, MN 56303-1255
(320) 251-8385
Mailing address
824 15TH AVE N, SARTELL, MN 56377-1999
(320) 202-2299
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
042674
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00265286
MEDICARE RAILROAD
MN
Enumeration date
03/23/2007
Last updated
01/14/2008
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