Provider Demographics
NPI:1538109335
Name:KREMER, RANDY L (CRNA)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:L
Last Name:KREMER
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR19754367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10338OtherNDBS # 10338
ND50209KROtherMNBS #
ND2000782OtherMEDICA FARGO #
ND947812OtherARAZ #
ND047843100Medicaid
ND12644Medicaid
ND2000781OtherMEDICA INNOVIS #
ND142338OtherUCARE #
NDDA9011015552OtherPREF 1 #
NDHP38624OtherHEALTHPARTNERS #
ND430017347Medicare ID - Type UnspecifiedRAILROAD MEDICARE #
ND047843100Medicaid
ND713033Medicare PIN
ND10338Medicare ID - Type UnspecifiedNDMD#