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General NPI Number Information
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NPI Number | 1912267642
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Entity Type | Individual
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Provider Name | BRANDON THIEMANN CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 6401 FRANCE AVE S
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City | EDINA
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State | MN
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Zip | 55435-2104
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Country | US
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Telephone | 612-672-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 10405 45TH AVE N APT 126
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City | PLYMOUTH
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State | MN
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Zip | 55442-3404
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Country | US
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Telephone | 612-718-1074
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R179024-1
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License Number State | MN
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