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Organization

GRAND FORKS ANESTHESIA SERVICES PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LORI BAZEY CRNA (OWNER)
(218) 779-9048
Entity
Organization

Contact information

Practice address
3035 DEMERS AVE, GRAND FORKS, ND 58201-4040
(701) 775-3151
Mailing address
3366 DESERT STAR LN, GRAND FORKS, ND 58201-5823
(701) 746-7441
(701) 746-7447

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R22456
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010322500
MN
01
05522001
BCBS
ND
05
11925
ND
01
765D7GR
BCBS
MN
01
CJ6769
RR MEDICARE
Enumeration date
08/23/2006
Last updated
04/23/2008
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