Healthcare Provider Details

I. General information

NPI: 1992755268
Provider Name (Legal Business Name): CRAIG ROBERT HALL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NORTH AVE
NORTHFIELD MN
55057-1498
US

IV. Provider business mailing address

1628 CANNON VALLEY DR
NORTHFIELD MN
55057-3362
US

V. Phone/Fax

Practice location:
  • Phone: 507-646-1000
  • Fax:
Mailing address:
  • Phone: 507-663-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR-119052-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: