Healthcare Provider Details

I. General information

NPI: 1255386207
Provider Name (Legal Business Name): RENEA MARIE PALMER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEA MARIE WOODLAND CRNA

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 FRANCE AVE SO.
EDINA MN
55435-2104
US

IV. Provider business mailing address

6401 FRANCE AVE SO. FAIRWIEW SOUTHDALE HOSPITAL
EDINA MN
55435-2104
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-5185
  • Fax:
Mailing address:
  • Phone: 952-924-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR1374256
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: