Provider Demographics
NPI:1316948813
Name:CAVALIER, CHRISTIAN T (CRNA)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:T
Last Name:CAVALIER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 BEAR ISLAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-8310
Mailing Address - Country:US
Mailing Address - Phone:218-820-7119
Mailing Address - Fax:
Practice Address - Street 1:2760 BEAR ISLAND RIVER RD
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-8310
Practice Address - Country:US
Practice Address - Phone:218-820-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1464315367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN372163900Medicaid
MN430005067Medicare ID - Type UnspecifiedMC