Healthcare Provider Details

I. General information

NPI: 1730206236
Provider Name (Legal Business Name): SHAUNA GANSEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 4TH AVE SW
PIPESTONE MN
56164-1890
US

IV. Provider business mailing address

916 4TH AVE SW
PIPESTONE MN
56164-1890
US

V. Phone/Fax

Practice location:
  • Phone: 507-825-5700
  • Fax: 507-825-6106
Mailing address:
  • Phone: 507-825-5700
  • Fax: 507-825-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR030241
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR229714-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: