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NPI Code Detail

MEDICARE: ANITA M PAKIZ CRNA

MEDICARE: ANITA M PAKIZ 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 AnesthetistR108101-5MN

General Provider Information

NPI Number : 1588611222
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITA M PAKIZ CRNA
Provider Business Mailing Address
First Line : 16049 NORTHWOOD RD NW
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-1611
Country : US
Telephone Number : 952-440-5880
Fax Number :
Provider Business Practice Location Address
First Line : 1455 SAINT FRANCIS AVE
Second Line :
City : SHAKOPEE
State : MN
Zip : 55379-3374
Country : US
Telephone Number : 612-403-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 07/08/2007

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