Provider Demographics
NPI:1306450440
Name:VANLANINGHAM, JEREMY LEE (DNP, APRN, CRNA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:LEE
Last Name:VANLANINGHAM
Suffix:
Gender:M
Credentials:DNP, APRN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 DUCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1027
Mailing Address - Country:US
Mailing Address - Phone:763-442-0807
Mailing Address - Fax:
Practice Address - Street 1:1256 DUCKWOOD DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1027
Practice Address - Country:US
Practice Address - Phone:763-442-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-05
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN195708-4163W00000X
MN2876367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse