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General NPI Number Information
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NPI Number | 1275639494
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Entity Type | Individual
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Provider Name | PATRICIA J MANSER CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 2080 WOODWINDS DR
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City | WOODBURY
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State | MN
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Zip | 55125-2523
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Country | US
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Telephone | 651-735-0501
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Fax | 651-735-1870
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Provider Business Mailing Address
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Address Line | 8681 EAGLE POINT BLVD
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City | LAKE ELMO
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State | MN
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Zip | 55042-8628
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Country | US
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Telephone | 651-251-8021
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Fax | 651-251-8050
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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 | R0960823
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License Number State | MN
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