Provider Demographics
NPI:1154378529
Name:SUTHERLAND, LORI ANN (CRNA)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:SUTHERLAND
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 1:39076 SISSEBAKWET SHORES RD
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MN
Mailing Address - Zip Code:55721-8968
Mailing Address - Country:US
Mailing Address - Phone:218-326-6158
Mailing Address - Fax:
Practice Address - Street 1:27040 COUNTY ROAD 9
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5456
Practice Address - Country:US
Practice Address - Phone:218-751-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1281022163W00000X
MN051013367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse