Individual
PAUL BRIAN MENCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
559 CAPITOL BLVD, SAINT PAUL, MN 55103-2101
(651) 232-2000
(651) 232-2118
Mailing address
8838 LAKE JANE TRL N, LAKE ELMO, MN 55042-8518
(651) 770-5258
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R080775-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138742100
—
MN
Enumeration date
05/10/2006
Last updated
08/23/2012
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