Provider Demographics
NPI:1982050746
Name:TIMBERWOLF ANESTHESIA SC
Entity Type:Organization
Organization Name:TIMBERWOLF ANESTHESIA SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERLANDSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CRNA
Authorized Official - Phone:612-839-4551
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:14054 BANK ST
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-0100
Mailing Address - Country:US
Mailing Address - Phone:763-260-8808
Mailing Address - Fax:
Practice Address - Street 1:502 S GLEN TRL
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-5497
Practice Address - Country:US
Practice Address - Phone:612-839-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty