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General NPI Number Information
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NPI Number | 1881684496
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Entity Type | Organization
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Legal Business Name | RIVER VALLEY ANESTHESIA P.A.
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 824 N 11TH ST
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City | MONTEVIDEO
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State | MN
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Zip | 56265-1629
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Country | US
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Telephone | 888-209-0305
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Fax | 952-442-3620
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Provider Business Mailing Address
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Address Line | 400 E 10TH ST
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City | WACONIA
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State | MN
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Zip | 55387-4552
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Country | US
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Telephone | 888-209-0305
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Fax | 952-442-3620
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Authorized Official
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Title or Position | OWNER
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Name | JEANNE MURPHY
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Credential | CRNA
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Telephone | 320-321-8154
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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 |
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License Number State |
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