Healthcare Provider Details

I. General information

NPI: 1487624433
Provider Name (Legal Business Name): CEDAR VALLEY ANESTHESIA ASSOC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 9TH ST
WAVERLY IA
50677
US

IV. Provider business mailing address

400 E 10TH ST
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 319-352-4120
  • Fax:
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT DORPINGHAUS
Title or Position: OWNER
Credential: CRNA
Phone: 319-352-4957