Healthcare Provider Details

I. General information

NPI: 1063961365
Provider Name (Legal Business Name): ANDREW GWOST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426-4702
US

IV. Provider business mailing address

5829 ABBOTT AVE S
EDINA MN
55410-2811
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-5000
  • Fax:
Mailing address:
  • Phone: 701-388-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR2013118
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2013
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: