Healthcare Provider Details

I. General information

NPI: 1457339780
Provider Name (Legal Business Name): NORTH METRO ANESTHESIA SERVICES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 FAIRVIEW BLVD
WYOMING MN
55092-8013
US

IV. Provider business mailing address

5200 FAIRVIEW BLVD
WYOMING MN
55092-8013
US

V. Phone/Fax

Practice location:
  • Phone: 651-464-4611
  • Fax: 651-464-7627
Mailing address:
  • Phone: 651-464-4611
  • Fax: 651-464-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: THERESA M WELTY
Title or Position: CORPORATE FINANCIAL OFFICER
Credential: CRNA
Phone: 651-464-4611