Provider Demographics
NPI:1669447934
Name:ENROTH, BYRON W (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:W
Last Name:ENROTH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:BYRON
Other - Middle Name:W
Other - Last Name:ENROTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:3055 ROSEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2741
Mailing Address - Country:US
Mailing Address - Phone:763-551-9086
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1512
Practice Address - Country:US
Practice Address - Phone:612-672-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR- 081879-7367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered