Provider Demographics
NPI:1467684449
Name:THILGEN, RANDY M (CRNA)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:M
Last Name:THILGEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20617 HAMPSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4670
Mailing Address - Country:US
Mailing Address - Phone:952-836-5022
Mailing Address - Fax:
Practice Address - Street 1:20617 HAMPSHIRE WAY
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4670
Practice Address - Country:US
Practice Address - Phone:952-836-5022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1681334367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered