Provider Demographics
NPI:1902204662
Name:WERMAGER, DAVID DOUGLAS (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DOUGLAS
Last Name:WERMAGER
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 1:508 2ND ST N
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-9189
Mailing Address - Country:US
Mailing Address - Phone:602-326-6084
Mailing Address - Fax:
Practice Address - Street 1:508 2ND ST N
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-9189
Practice Address - Country:US
Practice Address - Phone:602-326-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104981367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered