Healthcare Provider Details

I. General information

NPI: 1770710659
Provider Name (Legal Business Name): SWEET DREAMS ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 44TH AVE S
GRAND FORKS ND
58201-3434
US

IV. Provider business mailing address

6615 LAKE DR
GRAND FORKS ND
58201-8321
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-2222
  • Fax:
Mailing address:
  • Phone: 701-746-7441
  • Fax: 701-746-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberR1577341
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberR1577341
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberR27377
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberR27377
License Number StateND

VIII. Authorized Official

Name: HEIDI STAHL
Title or Position: OWNER
Credential: CRNA
Phone: 701-741-0545