Healthcare Provider Details

I. General information

NPI: 1609883958
Provider Name (Legal Business Name): VERDELL ALLEN BJERKETVEDT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VERDELL ALLEN BJERKETVEDT CRNA

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BECKER AVE SW
WILLMAR MN
56201-3302
US

IV. Provider business mailing address

8066 15TH AVE SW
PENNOCK MN
56279-9751
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-4120
  • Fax:
Mailing address:
  • Phone: 320-235-7759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 077826-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberR 077826-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: