Healthcare Provider Details

I. General information

NPI: 1154886232
Provider Name (Legal Business Name): MATTHEW ONOFRIO APRN, CRNA, DNAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SMITH AVE N
SAINT PAUL MN
55102-2344
US

IV. Provider business mailing address

2355 HIGHWAY 36 W STE 400
ROSEVILLE MN
55113-3905
US

V. Phone/Fax

Practice location:
  • Phone: 651-697-5804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2306
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: