Provider Demographics
NPI:1730342601
Name:LAKES ADVANCED PAIN SPECIALISTS PLLC
Entity type:Organization
Organization Name:LAKES ADVANCED PAIN SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KAPFER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:612-382-4613
Mailing Address - Street 1:10513 STONEBRIDGE TRL N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9569
Mailing Address - Country:US
Mailing Address - Phone:612-382-4613
Mailing Address - Fax:
Practice Address - Street 1:10513 STONEBRIDGE TRL N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-9569
Practice Address - Country:US
Practice Address - Phone:612-382-4613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 135016-0367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty