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General NPI Number Information
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NPI Number | 1124135546
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Entity Type | Organization
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Legal Business Name | GRAND FORKS ANESTHESIA SERVICES PC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 3035 DEMERS AVE
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City | GRAND FORKS
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State | ND
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Zip | 58201-4040
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Country | US
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Telephone | 701-775-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 3366 DESERT STAR LN
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City | GRAND FORKS
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State | ND
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Zip | 58201-5823
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Country | US
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Telephone | 701-746-7441
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Fax | 701-746-7447
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Authorized Official
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Title or Position | OWNER
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Name | LORI BAZEY
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Credential | CRNA
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Telephone | 218-779-9048
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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 | R22456
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License Number State | ND
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