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General NPI Number Information
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NPI Number | 1861034662
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Entity Type | Organization
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Legal Business Name | SIESTA ANESTHESIA SERVICES
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Dates
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Enumeration Date | 10/13/2019
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1120 COLLEGE DR STE 100
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City | BISMARCK
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State | ND
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Zip | 58501-1225
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Country | US
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Telephone | 701-760-8606
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Fax | 701-760-8050
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Provider Business Mailing Address
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Address Line | 1120 COLLEGE DR STE 100
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City | BISMARCK
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State | ND
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Zip | 58501-1225
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Country | US
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Telephone | 701-471-0081
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Fax |
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Authorized Official
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Title or Position | CRNA PRESIDENT
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Name | JACQUELINE M MATERI
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Credential |
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Telephone | 701-471-0081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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