MEDICARE: GARNET AANENSON

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
1	347C00000X	Private Vehicle	H748001536619	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	420M7MC	OTHER	MN	BLUE CROSS/BLUE SHIELD PL

General Provider Information

NPI Number	:	1124100326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARNET AANENSON

Provider Business Mailing Address
First Line	:	430 STATE STREET NW
Second Line	:
City	:	MCINTOSH
State	:	MN
Zip	:	56556-0247
Country	:	US
Telephone Number	:	218-563-2753
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 STATE STREET NW
Second Line	:
City	:	MCINTOSH
State	:	MN
Zip	:	56556-0247
Country	:	US
Telephone Number	:	218-563-2753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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