Healthcare Provider Details

I. General information

NPI: 1760410963
Provider Name (Legal Business Name): COLEEN SUE HELBERG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 SAINT FRANCIS AVE
SHAKOPEE MN
55379-3374
US

IV. Provider business mailing address

3191 LAKE BLUFF CIR NW
PRIOR LAKE MN
55372-1661
US

V. Phone/Fax

Practice location:
  • Phone: 952-403-2305
  • Fax:
Mailing address:
  • Phone: 952-226-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 125341-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: