Healthcare Provider Details

I. General information

NPI: 1285733196
Provider Name (Legal Business Name): JANICE C ANDERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 CLEARWATER DR CHILDRENS HEALTH CARE WEST
MINNETONKA MN
55343
US

IV. Provider business mailing address

2910 CENTRE POINTE DR CHILDRENS HEALTH CARE 35-121A
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 952-930-8600
  • Fax:
Mailing address:
  • Phone: 651-855-2109
  • Fax: 651-855-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0983266
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: