Healthcare Provider Details

I. General information

NPI: 1285139865
Provider Name (Legal Business Name): LEVI GARRETT LA PORTE APRN/CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DULUTH CLINIC 400 EAST THIRD STREET
DULUTH MN
55805-1951
US

IV. Provider business mailing address

ESSENTIA HEALTH DULUTH CLINIC MCL2CRED 400 EAST THIRD STREET
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 218-786-3146
  • Fax: 218-722-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR191403-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: