Amanda M Boland, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · St Louis Park, MN
NPI 1649249202 · NPPES record last updated Mar 24, 2015
Key facts
- NPI
- 1649249202
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- R 144590-7 (MN)
- Practice address
- 6500 Excelsior Blvd
St Louis Park, MN 55426-4702 - Phone
- (952) 993-5222
- NPI assigned
- Mar 16, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mngi Digestive Health PA
Park Nicollet Methodist Hospital
Practice addresses (Care Compare)
3001 Broadway St NE
Suite 500
Minneapolis, MN 55413-2197
Phone (612) 871-1145
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-5000
Hospital & facility affiliations
- Park Nicollet Methodist Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060127000497 | MN | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 9335153444 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 144590-7 | MN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Methodist Hospital | Current |
Accepting new patients | |
| Park Nicollet Methodist Hospital | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Mngi Digestive Health, P.a. | Current |
Accepting new patients |
Locations
5705 W Old Shakopee Rd
Ste 150
Bloomington, MN 55437
Phone (612) 870-5530
9145 Springbrook Dr NW
Ste 200
Coon Rapids, MN 55433
Phone (612) 625-8999
3001 Broadway St NE
Ste 500
Minneapolis, MN 55413
Phone (612) 870-5557
15700 37th Ave N
Plymouth, MN 55446
Phone (763) 577-0008
14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779
15700 37th Ave N
Ste 300
Plymouth, MN 55446
Phone (612) 870-5555
6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R 144590-7 | MN | Yes |
Addresses
Primary practice location
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Mailing address
6465 Wayzata Blvd
Ste 315
St Louis Park, MN 55426-1728
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 393079300 | Medicaid | MN |
Other providers in St Louis Park, MN
- Joanna Bobbitt
- Haleigh Ann Bodeau
- Kevin Herbert Boegel
- Mikel Karl Bofenkamp
- Chelsea Bohmer
- Erica D Bolden
- Lisa M Bolin
- Alexis Rose Boll
- Ruth Bolton
- Julie S Boman
All providers in St Louis Park, MN · Certified Registered Nurse Anesthetist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.