Healthcare Provider Details

I. General information

NPI: 1619003381
Provider Name (Legal Business Name): MICHELLE L RESLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE L FINES CRNA

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 23RD AVE S
FARGO ND
58104
US

IV. Provider business mailing address

737 BROADWAY N
FARGO ND
58102-4421
US

V. Phone/Fax

Practice location:
  • Phone: 701-417-6428
  • Fax: 701-417-3726
Mailing address:
  • Phone: 701-234-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR29076
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: