Provider Demographics
NPI:1972854586
Name:SHEWCHUK, KRISTI (CRNA)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:SHEWCHUK
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 1:505 14TH CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-2100
Mailing Address - Country:US
Mailing Address - Phone:612-239-5819
Mailing Address - Fax:
Practice Address - Street 1:505 14TH CT
Practice Address - Street 2:
Practice Address - City:SOUTH SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-2100
Practice Address - Country:US
Practice Address - Phone:612-239-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2013-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1651225163W00000X
MN89232367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse