Healthcare Provider Details

I. General information

NPI: 1003973157
Provider Name (Legal Business Name): TIMOTHY ANDRE KLASSEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

41130 620TH AVE
BUTTERFIELD MN
56120-4075
US

IV. Provider business mailing address

41130 620TH AVE
BUTTERFIELD MN
56120-4075
US

V. Phone/Fax

Practice location:
  • Phone: 507-956-3249
  • Fax:
Mailing address:
  • Phone: 507-956-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 146066-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: