Healthcare Provider Details

I. General information

NPI: 1548217094
Provider Name (Legal Business Name): MARY B QUAAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 1ST ST SUITE 101
DULUTH MN
55805-2201
US

IV. Provider business mailing address

14700 28TH AVE N SUITE 20
PLYMOUTH MN
55447-4835
US

V. Phone/Fax

Practice location:
  • Phone: 218-279-6200
  • Fax:
Mailing address:
  • Phone: 763-559-3779
  • Fax: 763-450-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR125091-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: