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Individual

BARRY L BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-3152
(612) 904-4218
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-6005
(612) 630-8242

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
38132
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8T915BE
BLUE CROSS BLUE SHIELD
MN
01
P00231816
MEDICARE RAILROAD
MN
Enumeration date
06/06/2006
Last updated
11/27/2007
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