Healthcare Provider Details

I. General information

NPI: 1669422663
Provider Name (Legal Business Name): JAY W CAYWOOD CRNA
Entity Type: Individual
Gender: Male
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

5093 BENSON RD
HERMANTOWN MN
55810-2509
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-5555
  • Fax:
Mailing address:
  • Phone: 218-729-4957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0893796
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: