Organization
DICKINSON COUNTY ANESTHESIA SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA JOHNSON CRNA (OWNER)
(712) 336-1230
Entity
Organization
Contact information
Practice address
HWY 71 SOUTH, SPIRIT LAKE, IA 51360
(712) 336-1230
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0926642
—
IA
01
—
10299
BLUE CROSS OF IA
IA
Enumeration date
07/10/2006
Last updated
08/06/2008
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