Healthcare Provider Details

I. General information

NPI: 1457700783
Provider Name (Legal Business Name): JESSICA ANN BLISS DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HARVARD ST SE
MINNEAPOLIS MN
55455-0363
US

IV. Provider business mailing address

14364 WESTRIDGE DR
EDEN PRAIRIE MN
55347-1737
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-2926
  • Fax:
Mailing address:
  • Phone: 651-442-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA 1955
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: