Provider Demographics
NPI:1497831580
Name:CHANNEL, EILEEN M (CRNA)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:CHANNEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:323 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1601
Mailing Address - Country:US
Mailing Address - Phone:218-281-9200
Mailing Address - Fax:218-281-9224
Practice Address - Street 1:323 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1601
Practice Address - Country:US
Practice Address - Phone:218-281-9200
Practice Address - Fax:218-281-9224
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 148885-4367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR 148885-4OtherLICENSE
MNR 148885-4OtherLICENSE