Provider Demographics
NPI:1093348633
Name:KASAL, ANDREA ROSE (APRN, CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ROSE
Last Name:KASAL
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:ROSE
Other - Last Name:JUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13921 315TH ST
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-4631
Mailing Address - Country:US
Mailing Address - Phone:507-202-5833
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2595
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2452367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered