Provider Demographics
NPI:1861034662
Name:SIESTA ANESTHESIA SERVICES
Entity Type:Organization
Organization Name:SIESTA ANESTHESIA SERVICES
Other - Org Name:JOURNEY TO WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRNA PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-471-0081
Mailing Address - Street 1:1120 COLLEGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1225
Mailing Address - Country:US
Mailing Address - Phone:701-471-0081
Mailing Address - Fax:
Practice Address - Street 1:1001 GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0508
Practice Address - Country:US
Practice Address - Phone:701-471-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIESTA ANESTHESIA SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-13
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty