Provider Demographics
NPI:1053517748
Name:BRESINGHAM, IRENE (APN)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:BRESINGHAM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:BRESINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:920 2ND AVE S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-3318
Mailing Address - Country:US
Mailing Address - Phone:612-659-7101
Mailing Address - Fax:484-450-2617
Practice Address - Street 1:11200 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8208
Practice Address - Country:US
Practice Address - Phone:815-464-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209000423OtherLICENSE
ILK49119Medicare UPIN
ILK49120Medicare UPIN