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NPI Code Detail

MEDICARE: ROBERT A LARTER CRNA

MEDICARE: ROBERT A LARTER CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistR 078455 9MN

General Provider Information

NPI Number : 1487647822
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT A LARTER CRNA
Provider Business Mailing Address
First Line : 14189 ELDERBERRY CT
Second Line :
City : GLENCOE
State : MN
Zip : 55336-8036
Country : US
Telephone Number : 320-864-5755
Fax Number :
Provider Business Practice Location Address
First Line : 1805 HENNEPIN AVE N
Second Line :
City : GLENCOE
State : MN
Zip : 55336-1416
Country : US
Telephone Number : 320-864-7725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 07/08/2007

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