Healthcare Provider Details

I. General information

NPI: 1770989642
Provider Name (Legal Business Name): MANITA DHUNGEL RN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 3RD ST DULUTH CLINIC
DULUTH MN
55805-1951
US

IV. Provider business mailing address

400 E 3RD ST DULUTH CLINIC
DULUTH MN
55805-1951
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR206961-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: