Provider Demographics
NPI:1457352650
Name:HEERWALD, JOANNE E (CRNA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:E
Last Name:HEERWALD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11223 WOODS TRL N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130
Practice Address - Country:US
Practice Address - Phone:651-254-8000
Practice Address - Fax:651-254-8084
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1024250367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46A73HEOtherBCBSMN
MN368722800Medicaid
MN430001996Medicare PIN