Healthcare Provider Details

I. General information

NPI: 1699754093
Provider Name (Legal Business Name): RICHARD ALLEN BURINGA C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W FOUNTAIN ST
ALBERT LEA MN
56007-2437
US

IV. Provider business mailing address

615 TROLLWOOD DR
ALBERT LEA MN
56007-4390
US

V. Phone/Fax

Practice location:
  • Phone: 507-373-2384
  • Fax:
Mailing address:
  • Phone: 507-373-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 100433-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: