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General NPI Number Information
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NPI Number | 1255323200
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Entity Type | Individual
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Provider Name | HAROLD W PEDERSEN CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 8990 SPRINGBROOK DR NW STE 250
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City | COON RAPIDS
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State | MN
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Zip | 55433-5850
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Country | US
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Telephone | 763-398-0099
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Fax | 763-398-0124
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Provider Business Mailing Address
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Address Line | 395 8TH ST NE APT 101
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City | MILACA
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State | MN
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Zip | 56353-1678
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Country | US
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Telephone |
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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 066992-0
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License Number State | MN
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