Healthcare Provider Details

I. General information

NPI: 1851570063
Provider Name (Legal Business Name): JOANNE HILL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNE SUMRALL CRNA

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

1906 HELENA RD N
OAKDALE MN
55128-5209
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3456
  • Fax:
Mailing address:
  • Phone: 651-246-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 130830-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: