Healthcare Provider Details

I. General information

NPI: 1730950684
Provider Name (Legal Business Name): TROY KING DIEGO DAQUIOAG DNP, APRN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 4TH ST SE
ROCHESTER MN
55904-4717
US

IV. Provider business mailing address

4412 MANOR BROOK DR NW
ROCHESTER MN
55901-3185
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-6600
  • Fax:
Mailing address:
  • Phone: 773-592-7032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2965
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: