Organization
PREMIER ANESTHESIA SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA BERUBE CRNA (CEO)
(612) 616-7731
Entity
Organization
Contact information
Practice address
1575 20TH ST NW # 205A, FARIBAULT, MN 55021-2930
(507) 209-6226
Mailing address
PO BOX 570, LAKE FOREST, IL 60045-0570
(800) 444-6110
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1731
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205223989
—
MN
Enumeration date
02/03/2018
Last updated
06/21/2018
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