Healthcare Provider Details

I. General information

NPI: 1154781342
Provider Name (Legal Business Name): ASHLEY M HANSMANN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2522
US

IV. Provider business mailing address

400 E 10TH ST
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 888-209-0305
  • Fax: 952-442-3620
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 212963-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: