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NPI Code Detail

MEDICARE: PETER YDSTIE CRNA

MEDICARE: PETER YDSTIE 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 AnesthetistR104550-1MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
256D99YDOTHERMNBLUE CROSS OF MN

General Provider Information

NPI Number : 1518993906
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER YDSTIE CRNA
Provider Business Mailing Address
First Line : 400 E 10TH ST
Second Line :
City : WACONIA
State : MN
Zip : 55387-4552
Country : US
Telephone Number : 952-442-9770
Fax Number : 952-442-3630
Provider Business Practice Location Address
First Line : 1095 HIGHWAY 15 S
Second Line :
City : HUTCHINSON
State : MN
Zip : 55350-5000
Country : US
Telephone Number : 320-234-4603
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 04/29/2008

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