Provider Demographics
NPI:1972568905
Name:KREMER, GLENN (CRNA)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:KREMER
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 1:1216 RYANS RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-1722
Mailing Address - Country:US
Mailing Address - Phone:507-372-6680
Mailing Address - Fax:507-372-6651
Practice Address - Street 1:1216 RYANS ROAD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2202
Practice Address - Country:US
Practice Address - Phone:507-372-6680
Practice Address - Fax:507-372-6651
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0856500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61435KROtherBLUE CROSS OF MN
MN525842100Medicaid
MN525842100Medicaid
MN430021830Medicare ID - Type UnspecifiedRAILROAD MEDICARE