Individual
ANNETTA M ATCHISON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 464-4611
(651) 464-7627
Mailing address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 464-4611
(651) 464-7627
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0730590
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43404100
—
WI
01
—
52B88AT
BLUE CROSS
MN
01
—
965621023600
PREFERREDONE
—
Enumeration date
01/26/2006
Last updated
07/08/2007
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