Healthcare Provider Details

I. General information

NPI: 1548717663
Provider Name (Legal Business Name): HANNA IONA SANDSTROM RN, CRNA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNA IONA LINDBERG

II. Dates (important events)

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

III. Provider practice location address

640 JACKSON ST
ST. PAUL MN
55101
US

IV. Provider business mailing address

PO BOX 1309 MAIL STOP 21110Q
MINNEAPOLIS MN
55440-1309
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR190418-9
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR34561
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number111885
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: