Healthcare Provider Details

I. General information

NPI: 1104284876
Provider Name (Legal Business Name): HEATHER JO FINC CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BEAM AVE
SAINT PAUL MN
55109-1126
US

IV. Provider business mailing address

337 WASHINGTON AVE N APT 531
MINNEAPOLIS MN
55401-2746
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-7300
  • Fax:
Mailing address:
  • Phone: 218-780-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1842
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: