Provider Demographics
NPI:1598842981
Name:PROBE, MANFRED HENRY (CRNA)
Entity type:Individual
Prefix:
First Name:MANFRED
Middle Name:HENRY
Last Name:PROBE
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 1:411 WATER ST SE
Mailing Address - Street 2:
Mailing Address - City:SLEEPY EYE
Mailing Address - State:MN
Mailing Address - Zip Code:56085-1773
Mailing Address - Country:US
Mailing Address - Phone:507-794-2225
Mailing Address - Fax:
Practice Address - Street 1:411 WATER ST SE
Practice Address - Street 2:
Practice Address - City:SLEEPY EYE
Practice Address - State:MN
Practice Address - Zip Code:56085-1773
Practice Address - Country:US
Practice Address - Phone:507-794-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN032954367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered