Healthcare Provider Details

I. General information

NPI: 1578720843
Provider Name (Legal Business Name): TERESA LOSCH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 CHICAGO AVE STE 300
MINNEAPOLIS MN
55407-1573
US

IV. Provider business mailing address

5813 VINCENT AVE S
MINNEAPOLIS MN
55410-2855
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-3779
  • Fax: 763-450-3986
Mailing address:
  • Phone: 612-929-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number080040
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: