Provider Demographics
NPI:1568868024
Name:CITROWSKE LEE, DANA LYN (CRNA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYN
Last Name:CITROWSKE LEE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYN
Other - Last Name:CITROWSKE DENEUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:10 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1820
Mailing Address - Country:US
Mailing Address - Phone:320-634-4521
Mailing Address - Fax:320-634-2244
Practice Address - Street 1:10 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1820
Practice Address - Country:US
Practice Address - Phone:320-634-4521
Practice Address - Fax:320-634-2244
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR173656-4367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered