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General NPI Number Information
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NPI Number | 1386891976
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Entity Type | Individual
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Provider Name | JESUS GERARDO BUENO APRN, CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 3300 OAKDALE AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2926
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Country | US
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Telephone | 763-581-3980
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Fax | 763-581-3591
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Provider Business Mailing Address
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Address Line | 5751 LONG BRAKE CIR S
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City | EDINA
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State | MN
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Zip | 55439-2619
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Country | US
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Telephone | 952-446-9222
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R1561564
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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 | CRNA1717
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License Number State | MN
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