Provider Demographics
NPI:1609883958
Name:BJERKETVEDT, VERDELL ALLEN (CRNA)
Entity type:Individual
Prefix:
First Name:VERDELL
Middle Name:ALLEN
Last Name:BJERKETVEDT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:VERDELL
Other - Middle Name:ALLEN
Other - Last Name:BJERKETVEDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:8066 15TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:PENNOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56279-9751
Mailing Address - Country:US
Mailing Address - Phone:320-235-7759
Mailing Address - Fax:
Practice Address - Street 1:301 BECKER AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3302
Practice Address - Country:US
Practice Address - Phone:320-231-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 077826-4163W00000X, 163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WP0000XNursing Service ProvidersRegistered NursePain Management