Healthcare Provider Details

I. General information

NPI: 1629050141
Provider Name (Legal Business Name): WILLIAM D OXNER RN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MAIN ST
WILLISTON ND
58801-4233
US

IV. Provider business mailing address

400 E 10TH ST
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 701-572-7711
  • Fax:
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR14281
License Number StateND

VIII. Authorized Official

Name: WILLIAM D OXNER
Title or Position: PRESIDENT
Credential: CRNA
Phone: 701-572-7711