Healthcare Provider Details

I. General information

NPI: 1629664560
Provider Name (Legal Business Name): ZOE K JOSTEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 FRANCE AVE S
EDINA MN
55435-2199
US

IV. Provider business mailing address

2210 PLYMOUTH RD APT 216
MINNETONKA MN
55305-2343
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-7004
  • Fax:
Mailing address:
  • Phone: 408-623-4583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2553
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: