Healthcare Provider Details

I. General information

NPI: 1194996926
Provider Name (Legal Business Name): RACHEL MARIE GOEHRING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 FRANCE AVE S
EDINA MN
55435-2104
US

IV. Provider business mailing address

14090 FOXTAIL LN
APPLE VALLEY MN
55124-5014
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-3779
  • Fax: 763-450-3986
Mailing address:
  • Phone: 952-683-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number078534
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: