MEDICARE: THOMAS EDWARD NOBLE 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
1	367500000X	Certified Registered Nurse Anesthetist	R 121151-3	MN

General Provider Information

NPI Number	:	1780646257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS EDWARD NOBLE CRNA

Provider Business Mailing Address
First Line	:	2545 CHICAGO AVE
Second Line	:	SUITE 311
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2545 CHICAGO AVE
Second Line	:	SUITE 311
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4522
Country	:	US
Telephone Number	:	612-871-7639
Fax Number	:	612-872-0302

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	07/08/2007

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