Healthcare Provider Details

I. General information

NPI: 1255333936
Provider Name (Legal Business Name): LINDA L OLMSTED CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 SPRINGBROOK DR NW STE 250
COON RAPIDS MN
55433-5850
US

IV. Provider business mailing address

19830 CHARTWELL HL
SHOREWOOD MN
55331-7034
US

V. Phone/Fax

Practice location:
  • Phone: 763-398-0099
  • Fax: 763-398-0124
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 145943-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: