Individual provider Active NPI

Deborah A Idland, CRNA

  • Certified Registered Nurse Anesthetist
  • Saint Cloud, MN
National Provider Identifier
1972620953
Registry record updated Jan 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
042674 Issued in ND
Practice address
1526 Northway Dr
Saint Cloud, MN 56303-1255
Phone
(320) 251-8385
NPI assigned
Mar 23, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 042674 ND Primary

Addresses

Primary practice location

1526 Northway Dr
Saint Cloud, MN 56303-1255

Mailing address

824 15TH Ave N
Sartell, MN 56377-1999
Phone (320) 202-2299

Other identifiers 1

IdentifierTypeStateIssuer
P00265286OtherMNMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116000368 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 2961466354 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
42674COMDAnatomic Pathology Physician
573MNMDNurse Practitioner
042674NDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Certified Anesthesia Care, Co. Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2026 Accepting new patients

Locations

9801 DuPont Ave S
Ste 100
Bloomington, MN 55431

1526 Northway Dr
Saint Cloud, MN 56303
Phone (320) 251-8385

400 10th St E
Waconia, MN 55387

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200268800000",
    "number": "1972620953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 15TH AVE N",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771999",
            "telephone_number": "320-202-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 NORTHWAY DR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031255",
            "telephone_number": "320-251-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDLAND",
        "first_name": "DEBORAH",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2008-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "042674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00265286",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.