Individual
JON FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4050 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2522
(763) 236-6000
(763) 236-6789
Mailing address
8990 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5884
(763) 398-0099
(763) 398-0124
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R105914-4
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
441652000
—
MN
01
—
451M8FI
BCBSMN
MN
Enumeration date
02/27/2006
Last updated
05/15/2008
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