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NPI Code Detail

MEDICARE: CLAIRE CRANDALL LEDUC RN, APRN, CRNA

MEDICARE: CLAIRE CRANDALL LEDUC RN, APRN, CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist190951-30WI
2367500000XCertified Registered Nurse Anesthetist182573-4MN

General Provider Information

NPI Number : 1053709022
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLAIRE CRANDALL LEDUC RN, APRN, CRNA
Provider Business Mailing Address
First Line : 11147 HARRISON AVE S
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55437-3249
Country : US
Telephone Number : 651-245-9855
Fax Number :
Provider Business Practice Location Address
First Line : 2000 NORTH AVE
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-1697
Country : US
Telephone Number : 507-646-1494
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2014
Last Update Date : 10/26/2022

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