Healthcare Provider Details

I. General information

NPI: 1992221907
Provider Name (Legal Business Name): KIRSTEN CRAWFORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN BOEKELHEIDE

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY N
FARGO ND
58102-3641
US

IV. Provider business mailing address

442 FOXTAIL DR
WEST FARGO ND
58078-7964
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-1230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR37859
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2170
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: