Individual
JERALD A KVASNICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R084245-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430021296
RAILROAD MEDICARE
MN
05
—
44378100
—
WI
05
—
889018800
—
MN
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
02/06/2006
Last updated
05/27/2021
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