Healthcare Provider Details

I. General information

NPI: 1295794261
Provider Name (Legal Business Name): GERALDINE A HERRIGES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

2545 CHICAGO AVE
MINNEAPOLIS MN
55404-4522
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-7639
  • Fax: 612-872-0302
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 108628-5
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA 0822
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: