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General NPI Number Information
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NPI Number | 1164126637
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Entity Type | Individual
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Provider Name | DUSTIN P HECK CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 1526 NORTHWAY DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1255
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Country | US
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Telephone | 320-251-8385
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Fax |
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Provider Business Mailing Address
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Address Line | 10155 45TH AVE NE
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City | SAUK RAPIDS
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State | MN
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Zip | 56379-2003
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Country | US
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Telephone | 320-287-0811
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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 | 2018142
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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 | 2834
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License Number State | MN
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