Provider Demographics
NPI:1881780146
Name:ANDRUSKI, HEIDI L (CRNA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:ANDRUSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LYNN
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:6615 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-8321
Mailing Address - Country:US
Mailing Address - Phone:701-746-7441
Mailing Address - Fax:701-746-7447
Practice Address - Street 1:1451 44TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3434
Practice Address - Country:US
Practice Address - Phone:701-780-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR27377367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00440923OtherRR MEDICARE
MN365M4STOtherBCBS
MN368665500Medicaid
ND24572OtherBCBS
ND13129Medicaid