Individual provider Active NPI

William Matthew Nettekoven, CRNA

  • Certified Registered Nurse Anesthetist
  • Saint Paul, MN
National Provider Identifier
1225545262
Registry record updated Sep 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2174 Issued in MN
Practice address
640 Jackson St
Saint Paul, MN 55101-2595
Phone
(651) 254-3456
NPI assigned
Dec 29, 2017
Last updated
Sep 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 222424-30 WI
Certified Registered Nurse Anesthetist 367500000X 12322-33 WI
Registered Nurse 163W00000X 2117153 MN
Certified Registered Nurse Anesthetist 367500000X 2174 MN Primary
Certified Registered Nurse Anesthetist 367500000X 114118-23 NH

Addresses

Primary practice location

640 Jackson St
Saint Paul, MN 55101-2595

Mailing address

8170 33Rd Ave S
Mailstop 21110Q
Bloomington, MN 55425-4516
Phone (952) 883-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI, NH3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20180226001006 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 2365703873 Reassigns benefits to 4 organizations
I20210401000637 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 2365703873 Reassigns benefits to 8 organizations
I20250509000538 NH Practitioner - Certified Registered Nurse Anesthetist (Crna) 2365703873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesiology, P.a.Group PAC ID 9335033034, 136 clinicians

Practice addresses (Care Compare)

1221 Whipple St
Eau Claire, WI 54703-5270
Phone (715) 838-3806

3300 N Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 520-5370

733 W Clairemont Ave
Eau Claire, WI 54701-6101
Phone (715) 838-5222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
2117153MNMDRegistered Nurse
222424-30WIMDRegistered Nurse
114118-23NHMDCertified Registered Nurse Anesthetist
12322-33WIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesiology, P.a. Nurse Anesthetist, Certified Registered CurrentSince Jul 22, 2025 Accepting new patients
Regions Hospital CurrentSince Dec 16, 2023 Accepting new patients
Baldwin Area Medical Center Inc. CurrentSince Feb 1, 2024 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Feb 23, 2021 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Feb 23, 2021 Accepting new patients
Hudson Hospital, Inc. CurrentSince Dec 13, 2025 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Dec 6, 2025 Accepting new patients
Hudson Hospital, Inc. CurrentSince Dec 13, 2025 Accepting new patients
Baldwin Area Medical Center, Inc. CurrentSince Feb 1, 2024 Accepting new patients
Ladd Memorial Hospital CurrentSince Feb 1, 2024 Accepting new patients
Westfields Hospital, Inc CurrentSince Dec 28, 2025 Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2019 Accepting new patients
Anesthesia Care Group PC CurrentSince May 2, 2025 Accepting new patients
University Anesthesia Providers, LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 28, 2020 Accepting new patients
Ladd Memorial Hospital CurrentSince Feb 1, 2024 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Dec 6, 2025 Accepting new patients
Westfields Hospital, Inc. Nurse Anesthetist, Certified Registered CurrentSince Dec 28, 2025 Accepting new patients

Locations

9855 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-5140

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

5 Alumni Dr
Exeter, NH 03833
Phone (603) 580-6339

88 McGregor St
Ste 303
Manchester, NH 03102
Phone (603) 647-9325

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

265 Griffin St E
Amery, WI 54001
Phone (715) 268-0308

1100 Bergslien St
Baldwin, WI 54002
Phone (715) 684-1111

733 W Clairemont Ave
Eau Claire, WI 54701
Phone (715) 838-3806

405 Stageline Rd
Hudson, WI 54016
Phone (715) 531-6000

535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013

2600 65th Ave
Osceola, WI 54020
Phone (705) 268-8000

Organizations & group practices 20

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 20

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789430400000",
    "number": "1225545262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MAILSTOP 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "952-883-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012595",
            "telephone_number": "651-254-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTEKOVEN",
        "first_name": "WILLIAM",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-29",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "222424-30",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "12322-33",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "2117153",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "2174",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NH",
            "license": "114118-23",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.