Basic Information
| Provider Information | |||||||||
| NPI: | 1063565802 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERRETT | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 737 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581220001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012346259 | ||||||||
| FaxNumber: | 7012347334 | ||||||||
| Practice Location | |||||||||
| Address1: | 737 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581220001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012346259 | ||||||||
| FaxNumber: | 7012347334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | R27402 | ND | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 24276 | 01 | ND BCBS | OTHER | 1034321 | 01 | PREFERREDONE | OTHER | 2002299 | 01 | MEDICA | OTHER | HP46105 | 01 | HEALTHPARTNERS | OTHER | 13019 | 05 | ND | MEDICAID | 798S0ER | 01 | MN BCBS | OTHER |