Provider Demographics
NPI:1407683915
Name:DRENTLAW, CARMEN JEAN (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:JEAN
Last Name:DRENTLAW
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 CROW WING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FORT RIPLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56449-1201
Mailing Address - Country:US
Mailing Address - Phone:320-241-0926
Mailing Address - Fax:
Practice Address - Street 1:320 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1645
Practice Address - Country:US
Practice Address - Phone:218-546-7000
Practice Address - Fax:218-546-4400
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2462622163W00000X
MN3026367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse