Healthcare Provider Details

I. General information

NPI: 1205145794
Provider Name (Legal Business Name): ERIK MICHAEL WATSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 9TH ST N
VIRGINIA MN
55792-2325
US

IV. Provider business mailing address

901 9TH ST N
VIRGINIA MN
55792-2325
US

V. Phone/Fax

Practice location:
  • Phone: 218-749-9457
  • Fax: 218-749-9427
Mailing address:
  • Phone: 218-749-9457
  • Fax: 218-749-9427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR198549-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: