Provider Demographics
NPI:1528411105
Name:ALBARES, ELISE ANN (APRN, CRNA)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:ANN
Last Name:ALBARES
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:ANN
Other - Last Name:WELKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,CRNA
Mailing Address - Street 1:640 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR185617-2367500000X
MNCRNA 1960367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered