Organization
TISUE ANESTHESIA SERVICES
Active
Organization
TISUE ANESTHESIA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILL TISUE CRNA (PARTNER)
(563) 382-1580
Entity
Organization
Contact information
Practice address
901 MONTGOMERY ST, DECORAH, IA 52101-2325
(319) 382-2911
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
(952) 442-3630
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0151928
—
IA
01
—
36893
BLUE CROSS OF IA
IA
Enumeration date
02/10/2006
Last updated
04/28/2008
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