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General NPI Number Information
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NPI Number | 1730342601
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Entity Type | Organization
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Legal Business Name | LAKES ADVANCED PAIN SPECIALISTS PLLC
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 10513 STONEBRIDGE TRL N
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City | STILLWATER
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State | MN
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Zip | 55082-9569
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Country | US
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Telephone | 612-382-4613
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Fax |
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Provider Business Mailing Address
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Address Line | 10513 STONEBRIDGE TRL N
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City | STILLWATER
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State | MN
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Zip | 55082-9569
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Country | US
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Telephone | 612-382-4613
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Fax |
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Authorized Official
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Title or Position | CRNA
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Name | MR. BRENT THOMAS KAPFER
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Credential | CRNA
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Telephone | 612-382-4613
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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 135016-0
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License Number State | MN
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