Individual
BENJAMIN B EVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Mailing address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R161934-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1113912
AMERICA'S PPO/ARAZ #
FM
05
—
1659328375
—
MN
01
—
2001730
MEDICA #
MN
01
—
23810
LHS/BANNERHEALTH #
MN
01
—
24215
NDBS #
MN
01
—
363J3EV
MNBS #
MN
05
—
973137700
—
MN
01
—
DA9031025578
PREFERRED ONE #
FM
01
—
HP38328
HEALTHPARTNERS #
MN
Enumeration date
05/28/2006
Last updated
07/16/2012
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