1912569658 NPI number — DANICA KATE GARDINER ELVESTER CRNA

Table of content: DANICA KATE GARDINER ELVESTER CRNA (NPI 1912569658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912569658 NPI number — DANICA KATE GARDINER ELVESTER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELVESTER
Provider First Name:
DANICA
Provider Middle Name:
KATE GARDINER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARDINER
Provider Other First Name:
DANICA
Provider Other Middle Name:
KATE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912569658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3144 CHOWEN AVE S APT 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-5446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-386-1348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55454-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-386-1348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  2379 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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