Basic Information
Provider Information
NPI: 1467594135
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KLINKNER
FirstName: DEANN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3300 OAKDALE AVE N
Address2:  
City: ROBBINSDALE
State: MN
PostalCode: 554222926
CountryCode: US
TelephoneNumber: 7635201926
FaxNumber: 7635205622
Practice Location
Address1: 1025 MARSH ST
Address2:  
City: MANKATO
State: MN
PostalCode: 560014752
CountryCode: US
TelephoneNumber: 5076254031
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/12/2007
LastUpdateDate: 12/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X821MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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