Healthcare Provider Details

I. General information

NPI: 1053361725
Provider Name (Legal Business Name): AMY L BUGGE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E 1ST ST
DULUTH MN
55805-2107
US

IV. Provider business mailing address

4907 LESTER RIVER RD
DULUTH MN
55804-3023
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-5555
  • Fax:
Mailing address:
  • Phone: 218-525-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0752769
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: