Healthcare Provider Details

I. General information

NPI: 1972735033
Provider Name (Legal Business Name): SHAWN MICHAEL OVERGAARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEDICAL CENTER DR
FAIRMONT MN
56031-4575
US

IV. Provider business mailing address

2101 SEURER ST
NEW MARKET MN
55054-5441
US

V. Phone/Fax

Practice location:
  • Phone: 507-238-8110
  • Fax: 507-238-8686
Mailing address:
  • Phone: 952-461-6196
  • Fax: 952-461-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 135182-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: