Provider Demographics
NPI:1194907543
Name:MUNROE, TARA (CRNA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MUNROE
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 1:400 10TH ST E
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:888-209-0305
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:925 HIGHLAND BLVD STE 1180
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6905
Practice Address - Country:US
Practice Address - Phone:406-582-4963
Practice Address - Fax:706-396-3252
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT087174367500000X
MTAPRN-100960367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1194907543Medicaid
MTM011002993Medicare PIN