Individual
RYAN C SPORTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 HEWITT BLVD, RED WING, MN 55066-2848
(651) 267-5000
Mailing address
11040 N STATE ROAD 77, HAYWARD, WI 54843-3606
(715) 934-4492
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
9368
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
9368
WI
367500000X
Certified Registered Nurse Anesthetist
R172650
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194987636
—
MN
Enumeration date
06/26/2008
Last updated
01/26/2023
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