Provider Demographics
NPI:1366823692
Name:FORSTER, MICHAEL DOUGLAS (CRNA, DNAP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:FORSTER
Suffix:
Gender:M
Credentials:CRNA, DNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15525 BARLEY RD NW
Mailing Address - Street 2:
Mailing Address - City:ROYALTON
Mailing Address - State:MN
Mailing Address - Zip Code:56373-8148
Mailing Address - Country:US
Mailing Address - Phone:320-310-2749
Mailing Address - Fax:
Practice Address - Street 1:815 2ND ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3596
Practice Address - Country:US
Practice Address - Phone:320-632-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2361367500000X
VA0001258086163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine