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General NPI Number Information
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NPI Number | 1932478096
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Entity Type | Individual
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Provider Name | RYAN JAMES EGEBERG CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 333 SMITH AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55102-2344
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Country | US
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Telephone | 651-735-0501
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Fax | 651-209-8077
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Provider Business Mailing Address
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Address Line | 8681 EAGLE POINT BLVD
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City | LAKE ELMO
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State | MN
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Zip | 55042-8628
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Country | US
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Telephone | 651-209-8071
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Fax | 651-209-8077
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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 | R1774254
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License Number State | MN
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