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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