Healthcare Provider Details

I. General information

NPI: 1063660173
Provider Name (Legal Business Name): STEPHANIE LYNN CZECH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 W OLD SHAKOPEE RD STE 150
BLOOMINGTON MN
55437-3126
US

IV. Provider business mailing address

5705 W OLD SHAKOPEE RD STE 150
BLOOMINGTON MN
55437-3126
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-1145
  • Fax:
Mailing address:
  • Phone: 612-871-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2038371
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2021
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: