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General NPI Number Information
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NPI Number | 1114023967
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Entity Type | Individual
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Provider Name | KIMBERLY DIANE RUPP-MONTPETIT CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 301 BECKER AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-3302
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Country | US
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Telephone | 320-231-4120
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Fax |
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Provider Business Mailing Address
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Address Line | 410 LAKE AVE S
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City | SPICER
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State | MN
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Zip | 56288-8614
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Country | US
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Telephone | 320-796-0434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R 116376-8
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License Number State | MN
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