Individual
BECCA SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3300 OAKDALE AVE N, ROBBINSDALE, MN 55422-2926
(763) 581-3980
Mailing address
3300 OAKDALE AVE N, ROBBINSDALE, MN 55422-2926
(763) 581-3980
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
145927
IA
163W00000X
Registered Nurse
221732-30
WI
163WC0200X
Critical Care Medicine Registered Nurse
R 204475-0
MN
207L00000X
Anesthesiology Physician
2044750
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
2144
MN
Other
Enumeration date
03/10/2017
Last updated
03/17/2018
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