Healthcare Provider Details

I. General information

NPI: 1346241478
Provider Name (Legal Business Name): ANN BERENS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N 7TH AVE
SHELDON IA
51201-1235
US

IV. Provider business mailing address

118 N 7TH AVE
SHELDON IA
51201-1235
US

V. Phone/Fax

Practice location:
  • Phone: 712-324-6020
  • Fax: 712-324-6025
Mailing address:
  • Phone: 712-324-6020
  • Fax: 712-324-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD065829
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: