Healthcare Provider Details

I. General information

NPI: 1437123627
Provider Name (Legal Business Name): SHELLY E COZINE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407
US

IV. Provider business mailing address

2854 HWY 55 STE 130, CAPITOL ANESTHESIA PA
EAGAN MN
55121
US

V. Phone/Fax

Practice location:
  • Phone: 865-342-8900
  • Fax: 865-691-0843
Mailing address:
  • Phone: 651-842-3344
  • Fax: 651-842-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1878
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: