Healthcare Provider Details

I. General information

NPI: 1073405791
Provider Name (Legal Business Name): EMMA BARTHOLOMEW CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER DR HITZELBERGER STRABE
LANDSTUHL GERMANY
66849
DE

IV. Provider business mailing address

1206 ASHLEY LN
MAHTOMEDI MN
55115-2837
US

V. Phone/Fax

Practice location:
  • Phone: 496-371-9464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3190
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: