Provider Demographics
NPI:1528008687
Name:ANTHONY, JOHN FRANCIS (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANCIS
Last Name:ANTHONY
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 1:322 W WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-3734
Mailing Address - Country:US
Mailing Address - Phone:507-387-6369
Mailing Address - Fax:
Practice Address - Street 1:1024 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4717
Practice Address - Country:US
Practice Address - Phone:507-345-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-075374-2367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
967551028142OtherPREFERRED ONE
0D572ANOtherBLUE SHIELD OF MN
115406OtherUCARE
2000848OtherMEDICA
HP57705OtherHEALTH PARTNERS
MN079843600Medicaid
MN079843600Medicaid