Provider Demographics
NPI:1255862108
Name:IANNAZZO, NATALIE ROSE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ROSE
Last Name:IANNAZZO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:ROSE
Other - Last Name:KATHOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:901 XENIA AVE S
Mailing Address - Street 2:APT 324
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1085
Mailing Address - Country:US
Mailing Address - Phone:605-760-3477
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2165367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered