Healthcare Provider Details

I. General information

NPI: 1275073892
Provider Name (Legal Business Name): NORTHLAND ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 5TH ST SE
COOK MN
55723-9702
US

IV. Provider business mailing address

PO BOX 432
PARK RAPIDS MN
56470-0432
US

V. Phone/Fax

Practice location:
  • Phone: 218-666-5945
  • Fax:
Mailing address:
  • Phone: 218-732-9464
  • Fax: 218-732-0249

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: GLEN D PALOKANGAS
Title or Position: OWNER
Credential: CRNA
Phone: 763-291-3669