Individual
DAVID KRUSEMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 MEDICAL CENTER DR, FAIRMONT, MN 56031-4575
(507) 238-8555
Mailing address
800 MEDICAL CENTER DR, PO BOX 800, FAIRMONT, MN 56031-4575
(507) 238-8555
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 084231-0
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171208
—
MN
01
—
20-03452
MEDICA
MN
01
—
4K003KR
BLUE CROSS
MN
05
—
4K003KR
—
MN
05
—
996066
—
IA
01
—
HP44201
HEALTH PARTNERS
MN
01
—
MH9041027355
PREFERRED ONE
MN
Enumeration date
12/07/2005
Last updated
07/09/2007
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