Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1417919002

Unknown Individual is a healthcare provider. based in Minneapolis, Minnesota. specializing in Certified Registered Nurse Anesthetist. They hold a License No. R0935528 (MN). The NPI Number for Unknown Individual is 1417919002

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1417919002
Phone
(763) 537-6000
Address
2104 NORTHDALE BLVD NW STE 220
Deactivation Date
15 November 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 2104 NORTHDALE BLVD NW STE 220

    MINNEAPOLIS, MN 554333046

    Phone: (763) 537-6000

    Fax: (763) 537-6666

    Type: Mailing

  • 7390 France Ave S

    Edina, MN 554354500

    Phone: (763) 537-6000

    Fax: (763) 537-6666

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

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Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55433)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1417919002 for Unknown Individual, then check state licensing separately.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Certified Registered Nurse Anesthetist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Minneapolis, Minnesota in our summary view.
Why does Unknown Individual have multiple addresses?
3 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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