Healthcare Provider Details

I. General information

NPI: 1598743718
Provider Name (Legal Business Name): KARYN E BARRY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 SAINT FRANCIS AVE ANESTHESIOLOGY
SHAKOPEE MN
55379-3374
US

IV. Provider business mailing address

14073 FLINTWOOD WAY STE 315
APPLE VALLEY MN
55124-3318
US

V. Phone/Fax

Practice location:
  • Phone: 952-403-3743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR112437-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: