Provider Demographics
NPI:1851497721
Name:PARENTEAU, WILLIAM M (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:PARENTEAU
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:8681 EAGLE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8628
Mailing Address - Country:US
Mailing Address - Phone:651-251-8021
Mailing Address - Fax:651-251-8050
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-735-0501
Practice Address - Fax:651-735-1870
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR1280324367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN709488400Medicaid
MN709488400Medicaid