Provider Demographics
NPI:1629795513
Name:NORMAN, KRISTOFFER BENJAMIN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:KRISTOFFER
Middle Name:BENJAMIN
Last Name:NORMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:BENJAMIN
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14683 390TH ST
Mailing Address - Street 2:
Mailing Address - City:GOODHUE
Mailing Address - State:MN
Mailing Address - Zip Code:55027-5007
Mailing Address - Country:US
Mailing Address - Phone:651-380-1965
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:55101-2595
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR153072163W00000X
MN2738367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse