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General NPI Number Information
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NPI Number | 1144553132
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Entity Type | Individual
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Provider Name | MARK ANDREW WATERMAN CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 155 RADIO DR
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City | SAINT PAUL
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State | MN
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Zip | 55125-2619
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Country | US
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Telephone | 952-831-8742
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Fax | 952-831-1626
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S MAILSTOP 21110Q
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone | 952-883-6000
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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 | 3295
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 7366-33
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 96660
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 166438-30
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1668700
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License Number State | MN
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