Healthcare Provider Details

I. General information

NPI: 1538463989
Provider Name (Legal Business Name): HEATHER MILLION LAYTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 01/06/2011
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

4432 ALDRICH AVE S
MINNEAPOLIS MN
55419-4822
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-7063
  • Fax:
Mailing address:
  • Phone: 612-823-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number086628
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: