Organization
WINNESHIEK MEDICAL CENTER
Active
Organization
WINNESHIEK MEDICAL CENTER
Active
Other names
WINNESHIEK MEDICAL CENTER ANESTHESIA
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M. RADTKE (CAO)
(563) 387-3145
Entity
Organization
Contact information
Practice address
901 MONTGOMERY ST, DECORAH, IA 52101-2325
(952) 442-9770
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
(952) 442-3630
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0736561
—
IA
01
—
23199
BLUE CROSS OF IOWA
IA
01
—
869T2WI
BLUE CROSS OF MN
MN
Enumeration date
07/28/2006
Last updated
07/25/2019
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