Organization
GLACIAL LAKES ANESTHESIA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J BEVERS CRNA (OWNER)
(507) 272-1629
Entity
Organization
Contact information
Practice address
1512 4TH ST NE, WATERTOWN, SD 57201-6824
(605) 884-0100
(952) 442-3620
Mailing address
400 10TH ST E, WACONIA, MN 55387-4552
(952) 442-9770
(952) 442-3620
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
12/08/2022
Last updated
12/08/2022
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