Healthcare Provider Details

I. General information

NPI: 1033155205
Provider Name (Legal Business Name): BETTY JANE KEMPER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE KEMPER CRNA

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

1403 50TH AVE N
MINNEAPOLIS MN
55430-4515
US

V. Phone/Fax

Practice location:
  • Phone: 865-342-8940
  • Fax:
Mailing address:
  • Phone: 701-720-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1245
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA 1919
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101290
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR26125
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000645
License Number StateSD
# 6
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209020563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: