Provider Demographics
NPI:1578927349
Name:WINTERBOER, ANDREW JAMES (CRNA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:WINTERBOER
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 1:39525 MALLARD VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:SD
Mailing Address - Zip Code:57427-5940
Mailing Address - Country:US
Mailing Address - Phone:605-691-1062
Mailing Address - Fax:
Practice Address - Street 1:2905 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5420
Practice Address - Country:US
Practice Address - Phone:605-626-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000913367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered