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General NPI Number Information
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NPI Number | 1972735033
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Entity Type | Individual
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Provider Name | SHAWN MICHAEL OVERGAARD CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 800 MEDICAL CENTER DR
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City | FAIRMONT
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State | MN
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Zip | 56031-4575
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Country | US
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Telephone | 507-238-8110
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Fax | 507-238-8686
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Provider Business Mailing Address
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Address Line | 2101 SEURER ST
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City | NEW MARKET
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State | MN
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Zip | 55054-5441
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Country | US
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Telephone | 952-461-6196
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Fax | 952-461-6196
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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 | R 135182-6
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License Number State | MN
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